El Paso County sits on the United States (US)-Mexico border and has a population of 827,398. Historically, women in the US-Mexico border have had some of the highest cervical cancer incidence and mortality rates in the country (mortality rate at 5.7/100,000 vs. 2.4/100,000 for the nation, age standardized to the year 2000 population). A majority (81.8%) of the population is Hispanic of Mexican descent and has unique socio-economic disadvantages, including a high poverty rate, low educational attainment and high proportion of residents without health insurance (36%) compared to Texas (25.2%) or the US (14.7%).

Cervical cancer is caused by a persistent infection with oncogenic genotypes ...

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El Paso County sits on the United States (US)-Mexico border and has a population of 827,398. Historically, women in the US-Mexico border have had some of the highest cervical cancer incidence and mortality rates in the country (mortality rate at 5.7/100,000 vs. 2.4/100,000 for the nation, age standardized to the year 2000 population). A majority (81.8%) of the population is Hispanic of Mexican descent and has unique socio-economic disadvantages, including a high poverty rate, low educational attainment and high proportion of residents without health insurance (36%) compared to Texas (25.2%) or the US (14.7%).

Cervical cancer is caused by a persistent infection with oncogenic genotypes of the Human Papillomavirus which is a very ubiquitous virus usually acquired during sexual activity. In the US, two vaccines have been approve to prevent infection against the most oncogenic types of Human Papillomavirus (HPV) to be given to males and females aged 9 – 26 years in three doses (0,2 and 6 months). Despite their proven efficacy, rates of initiation and completion of immunization series have been low across all racial/ethnic groups. Completion rates among teen females were 45.1% in El Paso, vs. 29.5% for Hispanics in the US and 34.8% overall in the Country. There is not data about completion rates in males or females aged 9 – 11 and 18 – 26 who are also eligible to receive the vaccine.

We have identified key barriers to vaccination completion in El Paso County through assessment of current literature, available data, and key informant interviews and have designed a program that addresses the needs of our community as well as gaps in services and creates a coordinated program of outreach, education, navigation and service delivery.

This is a multi-component evidence-based program designed to reduce cervical cancer burden among a predominantly Hispanic, low-income population in El Paso County. This program is a community program led by Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, in collaboration with community-based organizations. Key program components are: 1.) Outreach and community- based recruitment to primarily reach individuals with access to care barriers; 2.) an evidence-based educational intervention that is based on behavioral health theory and tailored to our community; 3.) navigation services provided by a bilingual navigator to match people with health care services; 4.) physician education and incorporation of prompts to remind physicians to recommend the vaccine; 5.) provision of no-cost HPV vaccine; and 6) a thorough evaluation of process and outcomes to facilitate replication.

The long-term goal of this program is to decrease the burden of cervical cancer on the Texas-Mexico border. Despite the proven effectiveness of HPV immunization, uptake remains low due to barriers that could be circumvented through education to improve awareness and knowledge about the vaccine in the community, strategies to increase health care providers’ recommendations of the vaccine, and increased access to the vaccine.

We will address the most salient barriers among a predominantly low-income Hispanic population in El Paso County in the following manner: 1.) Increase community awareness and knowledge about HPV vaccine, through education and outreach; 2.) increase health care provider recommendation for HPV vaccine through education and the incorporation of system reminders; and 3.) increase HPV vaccine uptake through navigation to match participants to available programs and by offering no-cost vaccine to those who do not qualify to any available program. Es tiempo de vacunarte!, It’s time to get vaccinated! aims at providing education to over 5,000 individuals from the community and health care providers and administering over 1,650 3-dose series vaccines. Our goals align with the CPRIT priority to reduce the impact of cervical cancer on the Texas border.

The innovation in our program involves the use of a multi-component program integrating available resources such as bilingual promotoras for education delivery, bridging this with navigation to available resources in the community and physician education and reminders thus addressing some of the most salient barriers for HPV uptake in our population. Increasing community awareness and knowledge of HPV vaccine as a means to prevent cervical cancer, increasing providers recommendation of the vaccine and providing no-cost vaccine to those who otherwise would not have access to it will impact the community at large by reducing the burden of HPV infection in the community, thereby reducing incidence of cervical cancer in the area.

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