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HPV Vaccination Rates Improve With Same-Day Vaccination In Dermatology Clinics

Vaccination rates for human papilloma virus (HPV) can be improved with in-office, same-day vaccination at dermatology sexually transmitted infection (STI) clinics, according to study findings published in the Journal of the American Academy of Dermatology.

Despite the increase in the population eligible for HPV vaccination, vaccination rates among Americans remain at 20% to 40% of women and 5% to 15% of men and lower still among minority populations. In the current study, researchers examined root causes for low vaccination rates and initiated a program to increase vaccination rates.

The researchers conducted a multi-phase education and vaccine initiation intervention among adults being treated for dermatologic sequalae of STIs at a single dermatology STI clinic in the United States. Across the entire study period, a prospective review was conducted of 175 patients with condyloma acuminata (CA) who presented to the clinic. Success for HPV vaccination initiation was determined by the number of eligible patients who received their first HPV vaccine dose within 3 months of their first visit to the STI clinic.

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This quality improvement project demonstrated that education and eligibility assessment for HPV vaccination with subsequent referral is insufficient to increase HPV vaccination rates.

The first phase of this quality improvement program was conducted from August 2019 through November 2019 and from August 2020 through November 2020, corresponding to the referral period prior to availability of in-office HPV vaccination. Phase 1 included documentation of counseling (included advocating for HPV vaccination of patient's partners) and assessment of vaccination eligibility (patients who were not vaccinated through 45 years of age) with referrals to gynecologists and primary care providers for eligible patients.

The second phase was conducted from September 2021 through December 2021 and from September 2022 through December 2022, when dermatologist-administered, same-day vaccinations were implemented.

The researchers found high rates for counseling and education, although overall initiation rates remained low in phase 1. The researchers noted 92.3% of eligible patients in phase 1 received counseling in 2019 and 89.5% of eligible patients received counseling in 2020. Vaccination initiation occurred in 33.3% of patients who presented in 2019 and 29.4% in 2020. In phase 2, 100% of eligible patients were counseled on vaccination in both 2021 and 2022, with 84.6% initiating vaccination in 2021 and 76.9% initiating vaccination in 2022.

The overall vaccination initiation rate in phase 1 was 31.7%, whereas the vaccination initiation rate in phase 2 was 80.8%. This represents a 175% increase in overall vaccine initiation (P <.01).

In phase 1, 34.9% of patients overall who initiated vaccination received the full 3-dose vaccination series. In phase 2, 72.0% of patients overall received 3 doses. Receipt of the full 3 dose series increased by 106.2% (P <.01). Further, an 80.9% reduction in the number of patients who did not receive a single dose of the vaccine was seen following the intervention (P <.01).

Study limitations include the underpowered sample size and results from this urban safety-net hospital may not be generalizable to smaller or rural practices. Additionally, no evaluation was made of the relationship between demographic factors and HPV vaccination.

"[HPV] is closely integrated into dermatologic practice, making dermatologists well-suited to counsel patients on HPV and vaccination, including offering HPV vaccine in dermatology clinics as one mechanism to improve access," the researchers wrote. They concluded, "This quality improvement project demonstrated that education and eligibility assessment for HPV vaccination with subsequent referral is insufficient to increase HPV vaccination rates. Same day administration of HPV vaccination is an essential step to improving HPV vaccination rates in a safety-net hospital and eliminating barriers to vaccine delivery."

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors' disclosures.

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