Need: HPV infection is the most common sexually transmitted infection (STI) in young sexually active populations and represents a serious public health problem as certain types (predominantly HPVs 16 and 18) have been associated with cancer of the cervix, vulva, vagina, anus, penis, oral cavity, and oropharynx. The economic burden of HPV infection is very high. At $127 per dose and nearly $400 per series, costs associated with initiating and completing the quadrivalent HPV vaccination schedule present significant barriers to service delivery especially for underinsured clients.

Between 2005 and 2010, both the age adjusted incidence and mortality rates of cervical cancer for the Houston-Sugar ...

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HPV infection is the most common sexually transmitted infection (STI) in young sexually active populations and represents a serious public health problem as certain types (predominantly HPVs 16 and 18) have been associated with cancer of the cervix, vulva, vagina, anus, penis, oral cavity, and oropharynx. The economic burden of HPV infection is very high. At $127 per dose and nearly $400 per series, costs associated with initiating and completing the quadrivalent HPV vaccination schedule present significant barriers to service delivery especially for underinsured clients.

Between 2005 and 2010, both the age adjusted incidence and mortality rates of cervical cancer for the Houston-Sugar Land-Woodlands and Beaumont-Port Arthur metropolitan statistical areas steadily equaled or surpassed similar rates for the state of Texas. A retrospective analysis of the patient population contained within Legacy Community Health Services’ electronic health record confirmed that 10,433 vaccine-eligible Legacy patients either never initiated the quadrivalent HPV vaccine schedule or failed to complete all three doses in 2013. Of these, 8,810 were never vaccinated. Baseline data indicate that 81.5% of all vaccine-eligible patients seen in 2013 failed to initiate the HPV vaccine schedule and only 57% of patients receiving the second dose ever received the third dose.

The target population includes males and females between the ages of 11-26 years who are vaccine-naïve and who come to Legacy for services. Critical barriers to current service delivery such as the high cost associated with completing the three dose vaccine series, logistical difficulties such as transportation and appointment scheduling, low patient health literacy around the preventive nature of the vaccine, and inconsistent medical provider recommendations regarding the quadrivalent vaccine continue to impede delivery of this preventative service to the target population.

Legacy Community Health Services, a Federally Qualified Health Center, proposes to increase HPV vaccination coverage by facilitating access to and increasing the completion rate for the quadrivalent HPV vaccine for all vaccine-eligible patients regardless of their ability to pay, through a comprehensive combination of evidence-based interventions that link patients to and see them through the completion of appropriate vaccines based on recommendations from The Community Guide. These combined evidence-based interventions at the systems-, provider-, and patient-levels will deliver increased vaccine-conferred immunity to cervical cancer. The combined interventions include an Opt-Out HPV Vaccinations, Standing Orders, Reducing Client Out-of-Pocket cost, Patient Reminders, Provider Reminders, Provider Assessment and Feedback, and Patient Education strategies in an effort to deliver the quadrivalent HPV vaccine.

The overall goal of the project is to increase the percentage of age-eligible patients initiating and completing the quadrivalent vaccine based on the Advisory Committee on Immunization Practices guidelines. The project will serve approximately 6,150 people and reach approximately 144,000 people. Legacy’s project creatively combines a comprehensive set of evidence-based interventions into an action oriented approach heretofore untested in a community health center setting that will improve vaccine-conferred immunity to cervical cancer across a large patient pool.

Moreover, Legacy has achieved Level 3 recognition as a Patient Centered Medical Home (PCMH) at one of its sites and is continuing this process for all its clinics. The PCMH model is better situated to manage the patient population that would benefit from these interventions by providing the full complement of services that help retain patients in care, link them to other clinical services, and educate them on ways to remain healthy.

Imagine a Texas that stops spending $77.4 million on the direct costs of cervical cancer; imagine the opportunity to erode the racial disparities of cervical cancer in the most racially diverse city in America; imagine a year when 1,219 Texas women do not hear the life-altering diagnosis of cervical cancer; finally, imagine a project that holds the potential to link all HPV-vaccine eligible patients to and see all patients through completion of the quadrivalent HPV vaccine. Legacy’s project, if funded by CPRIT, promises these unique and major impacts on cancer prevention and control by providing the quadrivalent HPV vaccine for patients while they are still young enough to have an impact on their entire lives thus putting significant downward pressure on future incidence and mortality rates for cervical cancer.

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