Adherence to the HPV Vaccine Dosing Intervals and Factors Associated With Completion of 3 Doses

Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH 45229-3039, USA.
PEDIATRICS (Impact Factor: 5.47). 01/2011; 127(1):77-84. DOI: 10.1542/peds.2010-0812
Source: PubMed


The objectives of this study were to determine (1) adherence to the immunization schedule for the human papillomavirus quadrivalent vaccine and (2) factors associated with completion of the 3-dose series.
This was a retrospective review of health information records from an academic medical center. The sample included all 9- to 26-year-old female patients who initiated vaccination within 2 years after quadrivalent vaccine availability. Multivariable logistic regression models were estimated to determine associations with completion of the 3-dose series within 7 and 12 months.
Among the 3297 female patients who initiated vaccination with human papillomavirus quadrivalent vaccine, 67% self-identified as black and 29% self-identified as white. Fewer than 3% of vaccine doses were received earlier than recommended, but >50% of doses were received late. Completion rates were 14% by 7 months and 28% by 12 months. Independent predictors of completion by 7 months included white versus black race (odds ratio [OR]: 2.04 [95% confidence interval (CI): 1.64-2.56]; P < .001), use of contraception that required intramuscular injections every 3 months (OR: 1.53 [95% CI: 1.12-1.95]; P < .001), and private versus public insurance (OR: 1.31 [95% CI: 1.06-1.63]; P < .05). Age and clinic type were not independent predictors of completion.
Adherence to recommended intervals and completion of the vaccine series were low. Lower rates of completion in black patients compared with white patients raises concern that disparities in vaccine completion could exacerbate existing disparities in cervical cancer.

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    • "In order to improve HPV vaccination, it is essential to understand current patterns of HPV vaccination. While previous research has primarily focused on HPV vaccine initiation and completion among adolescent girls, the adherence of recommended HPV dose schedules has not been well assessed [17] [18] [19] [20] [21] [22]. The objectives of this study were to: (1) examine HPV vaccine completion and dose adherence among commercially insured females who were aged 9 through 26 years old and had initiated HPV vaccination; (2) identify factors associated with HPV vaccine completion and dose adherence among these females. "
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    ABSTRACT: Background: Although HPV vaccination has been recommended for use in girls and young women since 2007, HPV vaccine uptake is low in the US. Methods: We conducted a retrospective cohort study using the 2008-2011 MarketScan data to examine HPV vaccine completion and dose adherence among commercially insured females aged 9-26 years. We performed multivariable logistic regression models to examine factors related to HPV vaccine completion and HPV vaccine dose adherence. Results: Among 378,484 females aged 9-26 years who initiated HPV vaccination, only 29.4% completed HPV vaccination. Compared with females receiving vaccines from primary care providers, those receiving vaccines from OB/GYN providers were more likely to complete the vaccine series. Age at HPV vaccine initiation, health insurance plan, seasonal pattern, and flu vaccination were also significantly associated with vaccine completion. Among 111,286 females who completed HPV vaccination, 62.4% received all doses within 30 days of the recommended schedules. Similar factors relating to HPV vaccine completion were consistently associated with HPV vaccine dose adherence. However, younger age (<22 years) and receipt of flu vaccine were negatively related to HPV vaccine dose adherence. Conclusions: Intervention programs to improve HPV vaccine reminding system and reduce logistic barriers for both physicians and patients are warranted.
    Full-text · Article · Nov 2015
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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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    • "Only one of these studies showed that publicly insured adolescents were significantly more likely to complete the HPV4 series than those with private or no insurance (Schluterman et al., 2011). Most adolescent studies showed that those with private insurance were significantly more likely to complete the on-time HPV4 series than those with public or no insurance (Dempsey et al., 2011; Dorell et al., 2011; Neubrand et al., 2009; Tan et al., 2011; Widdice et al., 2011). Our data show that among those adolescents receiving three doses, public and private insurance of HPV4 led to equivalent on-time completion rates. "
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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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