The goal of this 3-year CPRIT initial expansion project is to broaden the use of the evidence-based multi-level Adolescent Vaccination Program (AVP) to safety net clinic settings to increase HPV vaccination in clinic networks that reach underserved populations within Texas. HPV is a major cause of morbidity and mortality in men and women that can be reduced through vaccination. Persistent infection with high-risk HPV types cause over 70% of cervical cancers, 90% of anal cancers, 60-70% of oropharyngeal cancers, and 40% of vagina, vulva, and penile cancers. Low-risk HPV types cause 90% of genital warts. HPV-related morbidity and mortality can be reduced through vaccination. Despite evidence ...

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The goal of this 3-year CPRIT initial expansion project is to broaden the use of the evidence-based multi-level Adolescent Vaccination Program (AVP) to safety net clinic settings to increase HPV vaccination in clinic networks that reach underserved populations within Texas. HPV is a major cause of morbidity and mortality in men and women that can be reduced through vaccination. Persistent infection with high-risk HPV types cause over 70% of cervical cancers, 90% of anal cancers, 60-70% of oropharyngeal cancers, and 40% of vagina, vulva, and penile cancers. Low-risk HPV types cause 90% of genital warts. HPV-related morbidity and mortality can be reduced through vaccination. Despite evidence of safety and efficacy, and endorsement by professional organizations, HPV vaccination rates are well below the 2030 Healthy People target of 80%. Increasing uptake of HPV vaccination has the potential to improve health outcomes both short-term (e.g., pre-cancerous cervical lesions and genital warts) and long-term (e.g., adult-onset cancers) by preventing infection with HPV. Both parental and provider factors influence HPV vaccination uptake and completion among adolescents, thus there is a critical need for multi-level strategies to increase HPV vaccination coverage. We propose to leverage the success of our previous and current CPRIT projects that have developed the Adolescent Vaccination Program (AVP) and established its effectiveness. The AVP comprises a suite of recommended evidence-based strategies: immunization champions, provider assessment and feedback, provider reminders, provider continuing education, patient reminder and recall systems, and patient (parent) education. The AVP targeted healthcare providers and parents of patients (11-17 years) and was effective at increasing both initiation and completion of the HPV vaccine series among male and female patients in large pediatric clinic networks, initially in Texas Children's Pediatric Network and then in a replication trial at Children's Hospital of San Antonio Primary Care (CHPC) clinical network. In a current MD Anderson-funded project, we have adapted the AVP system- and provider-level strategies for implementation in safety net clinic systems. Leveraging this work, we propose to expand the evidence- and system-based AVP to non-profit safety net clinics (e.g., Ibn Sina and VCare clinical networks) to reach large numbers of underserved patients, including a high proportion of Hispanic patients. Specific goals and objectives are: Goal 1: Adapt the Adolescent Vaccination Program (AVP) for use by non-profit safety net clinics serving a high proportion of Hispanic patients (Mos. 1-6). Obj. 1.1: Survey 100% of the healthcare professionals at Ibn Sina and VCare clinics to assess individual and organizational factors that may influence current HPV vaccination practices and the implementation of program strategies. Obj. 1.2: Survey 100 Hispanic parents of patients ages 9-17 years at Ibn Sina and VCare clinics to assess parental factors related to HPV vaccination initiation and completion and adapt the parent education for Hispanic parents. Obj. 1.3: Assess acceptability (usability, feasibility) of the adapted AVP program with a target criterion of 70% agreement. Goal 2: Deliver the adapted AVP to healthcare professionals and parents of patients ages 9-17 years at Ibn Sina and VCare safety net clinics (Mos. 7-36). Obj. 2.1: Deliver the provider-based program to healthcare professionals (100%) in these clinics Obj. 2.2: Deliver the parent-based program to 1,500 parents of patients ages 9-17 in these clinics. Goal 3: Evaluate effectiveness of the AVP at increasing and maintaining HPV vaccine initiation and completion among male and female patients ages 9-17 in Ibn Sina and VCare safety net clinics (Mos. 12-34). Obj. 3.1: As a result of delivering the program, HPV vaccine initiation among male and female patients ages 9-17 will increase by at least 15% over baseline. Obj. 3.2: As a result of delivering the program, HPV vaccine completion among male and female patients ages 9-17 will increase by at least 15% over baseline. This project is significant because it will demonstrate if an innovative and successful multi-level HPV vaccination program (demonstrated effective in large clinic networks) can be effective when adapted and expanded to non-profit safety net clinics in Texas.

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