Correlates for Completion of 3-Dose Regimen of HPV Vaccine in Female Members of a Managed Care Organization

Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101, USA.
Mayo Clinic Proceedings (Impact Factor: 6.26). 10/2009; 84(10):864-70. DOI: 10.1016/S0025-6196(11)60503-X
Source: PubMed


To examine the rate and correlates of completion of the quadrivalent human papillomavirus vaccine (HPV4) 3-dose regimen because nonadherence to the regimen may adversely affect vaccine efficacy.
Female members of Kaiser Permanente Southern California who were 9 to 26 years old, received the first dose of HPV4 between October 2006 and March 2007, and maintained health plan membership 12 months afterward were identified and followed up for regimen completion. We examined the following: (1) demographics/socioeconomic status, (2) primary care physician characteristics, (3) historical health service utilization, (4) women's health-related conditions, and (5) selected immune-related conditions for their association with completion in 2 age groups: 9 to 17 years and 18 to 26 years. Multivariable log-binomial regression was used to directly estimate relative risk (RR).
Of the 34,193 females who initiated HPV4, the completion rate was 41.9% in the 9- to 17-year-old group and 47.1% in the 18- to 26-year-old group. Black race (RR, 0.70; 95% confidence interval [CI], 0.64-0.77) and lower neighborhood education level were associated with lower regimen completion. However, those in the 9- to 17-year-old group who were covered by the state-subsidized program Medi-Cal were more likely to complete the regimen (RR, 1.14; 95% CI, 1.07-1.22). Historical hospitalizations and emergency department visits (RR, 0.92; 95% CI, 0.87-0.96; and RR, 0.96; 95% CI, 0.94-0.98 per visit, respectively) and having a pediatrician were also predictors of noncompletion. A history of sexually transmitted diseases, abnormal Papanicolaou test results, and immune-related conditions (eg, asthma/infections) were not associated with regimen completion.
These findings suggest that factors such as race or socioeconomic status should be considered when human papillomavirus vaccination programs are being designed and evaluated.

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Available from: Jeff M Slezak, Oct 20, 2014
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    • "Other studies in young adult women have also found an association between vaccination status and being single, unmarried or never married (with the exact measure being study dependent) [12] [14] [15] [22]. The relationship identified in the current study between HPV vaccine uptake and use of hormonal contraception, has not been previously documented in the Australian National HPV Vaccination Program and has only been investigated in a few other international studies of young adult women [10] [11] [21] [23]. Hormonal contraception use may act as a proxy for accessing health services on a regular basis, thus possibly increasing the likelihood of vaccination in the catch-up phase, and/or it may indicate increased awareness of women's health issues [24]. "
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    ABSTRACT: Australia commenced a publically-funded, National Human Papillomavirus (HPV) Vaccination Program in 2007 with a two year catch-up phase for females aged 12-26 years. To identify the factors associated with the uptake of the HPV vaccine (which has a recommended 3-dose schedule in Australia) by young adult women vaccinated by general practitioners and community-based programs within the catch-up phase. 1139 women who were eligible to receive the free HPV vaccine during the catch-up period were recruited in 2008-2009 (age 20-29 years at recruitment), in New South Wales, after having a normal (negative) cervical smear result recorded on the NSW Pap Test Register. Participants completed a self-administered questionnaire providing information on vaccination status, and sociodemographic and other factors. Overall, 880 (77%) women reported receiving ≥1 dose of the vaccine and 777 women (68%) reported receiving ≥2 doses. In multivariable analysis (adjusting for the period for which each woman was eligible for free HPV vaccination), uptake of ≥1 dose of the vaccine was significantly associated with being born in Australia (p<0.01), being single (p=0.02), being nulliparous (p<0.01), living in a higher socioeconomic status area (p-trend=0.03), living in more remote areas (p=0.03), drinking alcohol (p<0.01) and using hormonal contraceptives (p<0.01). Although vaccinated women were more likely to have fewer sexual partners than unvaccinated women (p-trend=0.02), they were also more likely to report a prior sexually transmitted infection (STI) (p=0.03). Similar factors were associated with receiving ≥2 doses. In this group, women living in higher socioeconomic status areas were more likely to be vaccinated against HPV in the catch-up phase of the national program. Although vaccinated women tended to have fewer sexual partners, they also reported prior STIs, which may be a marker of increased risk of prior exposure to HPV. The findings of this study reinforce the continuing need to prioritise equitable delivery of vaccination to various population subgroups. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
    Full-text · Article · Apr 2015 · Vaccine
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    • "The on-time completion rate of the three dose series of quadrivalent human papillomavirus vaccine (HPV4) in the US has been poor (Centers for Disease Control and Prevention, 2012a, 2012b, 2011; Chao et al., 2009; Chou et al., 2011; Cook et al., 2010; Dempsey et al., 2010, 2011; Dorell et al., 2011; Gold et al., 2011; Hirth et al., 2012; Kessels et al., 2012; Neubrand et al., 2009; Niccolai et al., 2011; Perkins et al., 2012; Rouzier and Giordanella, 2010; Rubin et al., 2012; Schluterman et al., 2011; Smith et al., 2011; Tan et al., 2011; Tiro et al., 2012; Verdenius et al., 2013; Widdice et al., 2011). Factors influencing vaccine completion have included age, race/ethnicity, parity, and visit intention (Centers for Disease Control and Prevention, 2012a, 2012b; Chao et al., 2009; Chou et al., 2011; Cook et al., 2010; Dempsey et al., 2010, 2011; Dorell et al., 2011; Gold et al., 2011; Hirth et al., 2012; Kessels et al., 2012; Neubrand et al., 2009; Niccolai et al., 2011; Perkins et al., 2012; Rouzier and Giordanella, 2010; Rubin et al., 2012; Schluterman et al., 2011; Smith et al., 2011; Tan et al., 2011; Tiro et al., 2012; Verdenius et al., 2013; Widdice et al., 2011). In addition, studies about incentive systems to address increasing uptake of preventive health measures have proposed acting on the social determinants of health which contribute to behaviors that lead to health inequalities (Epstein et al., 2009). "
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    ABSTRACT: Economic incentives can positively influence social determinants to improve the health care of the uninsured and underserved populations. The aim of this study was to determine if free HPV4 vaccine would lead to on-time series completion in our safety net health care system in the US Midwest. A nested retrospective cohort study of females receiving HPV4 vaccine between 2006 and 2009 was conducted. Patient characteristics and payor source for each of the three HPV4 doses were abstracted from electronic records. Logistic regression was used to predict on-time completion rates. The proportion of adolescent and adult females completing three on-time HPV4 doses was equal (21% (28/136) vs. 18% (66/358), respectively) from among the 494 females receiving 927 HPV4 doses in this study. No adolescent receiving free HPV4 vaccine completed three doses. Grant sponsorship of at least one HPV4 dose among adults did not predict three dose on-time completion (OR=1.56, 95%CI: 0.80, 3.06). Neither was adult grant sponsorship of HPV4 significant when analyzing exclusive payor sources vs. a combination of payor sources (OR=0.72, 95%CI: 0.10, 5.17). Free HPV4 vaccine does not influence the on-time completion rates among adults.
    Full-text · Article · Jan 2014 · Preventive Medicine
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    • "In our sample, Whites, Blacks, and other races had positively skewed distributions (i.e., toward more education), whereas Hispanics had a negative skew. In contrast with several studies finding a positive effect of age on HPV vaccine uptake (Chao et al., 2010; Conroy et al., 2009; Dempsey et al., 2010; Gottlieb et al., 2009; Pruitt & Schootman, 2010), we found a null effect that likely reflects how we defined the variable (i.e., continuous vs. categorical). "
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    ABSTRACT: Background: Local data are often used to plan and evaluate public health interventions and policy. With increasingly fewer public resources to collect sufficient data to support direct estimation of local outcomes, methods for deriving small area estimates are vital. The purpose of this study is to describe the county-level geographic distribution of human papillomavirus (HPV) vaccine coverage among adolescent females in Texas using multilevel small area estimation. Methods: Multilevel (individual, county, public health region) random-intercept logit models were fit to HPV vaccination data (≥1 dose Gardasil) from the 2008 Behavioral Risk Factor Surveillance System. Using the parameter estimates from the final model, we simulated 10,000 data sets for each regression coefficient from the normal distribution and applied them to the logit model to estimate HPV vaccine coverage in each county. Results: County-level coverage estimates ranged from 7% to 29%, compared with the state average of 18% (95% confidence interval [CI], 13.59-21.88). Many Southwestern border and metropolitan counties exhibited high coverage estimates. Low coverage estimates were noted in the Panhandle, Southeastern border region, and Northeast. Significant correlations were observed between HPV vaccination and Hispanic ethnicity, county poverty, and public health region poverty. Conclusion: Harnessing the flexibility of multilevel small area models to estimate HPV vaccine coverage at the county level, we have provided data that may inform the development of health education programs/policies, the provision of health services, and the planning of new research studies. Additionally, we have provided a framework for modeling other health outcomes at the county level using national survey data.
    Full-text · Article · Mar 2013 · Women s Health Issues
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