BACKGROUND: Highly effective human papillomavirus (HPV) vaccines offer protection to both young men and women to safeguard against HPV infections and related cancers. The Advisory Committee on Immunization Practices (ACIP) recommends that all 11-12 year olds receive 1 dose of tetanus diphtheria pertussis (Tdap), 1 dose of meningococcal (MCV4) and 3 doses of HPV vaccine. For every 1 dose of Tdap given to adolescents, 3 doses of HPV vaccine should be administered for an ideal ratio of 1 Tdap to 3 HPV (1:3). The 2014 Teen National Immunization Survey (NIS-Teen) found that while Texas teens exhibited high vaccination coverage levels for Tdap and MCV4; only 33.9% of females and 17.7% of males had completed 3 doses of HPV vaccine despite the safety and efficacy of HPV vaccine. Texas has approximately 3,400 providers enrolled in the Texas Vaccines for Children (TVFC) program which offers free vaccine to eligible children in Texas; the state with highest uninsured rates in the country according to the Kaiser Family Foundation. The objective of the study was to identify characteristics of health care providers with low HPV vaccine utilization to assist in targeted interventions to improve HPV vaccination coverage in Texas.
METHODS: Vaccine ordering data for TVFC providers was examined to determine the Tdap to HPV vaccine ratio in 2014. Low HPV vaccine utilization was defined as having a ratio of less than 1 Tdap to 2.5 HPV vaccine ratio (<1:2.5) for vaccine orders. TVFC provider characteristics and data from the national provider education assessment and reporting (PEAR) database were examined for provider characteristics predictive of low HPV vaccine utilization. Logistic regression statistical analysis methods were applied using SAS 9.4.
RESULTS: In 2014, TVFC providers reflected an average Tdap to HPV vaccine ratio of 1:1.4, less than half the ideal ratio of 1:3. Additionally, three provider characteristic variables were identified as significant predictors of a low HPV vaccine utilization; patient population (0-18 years) less than 500, non-Texas Mexico border county location, and rural status.
CONCLUSIONS: A recent CDC survey found that a strong healthcare provider recommendation is the single best predictor of HPV vaccination. By identifying healthcare provider characteristics predictive of low HPV vaccine utilization, the Texas Department of State Health Services (DSHS) plans to target interventions aimed at improving HPV vaccine ordering and administration among TVFC providers in rural locations and those with small client populations.