Impact of Number of Providers and Facility Type on Human Papillomavirus Vaccination Coverage Open Access

Herring, Meghan (Spring 2020)

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Human Papillomavirus (HPV) vaccination coverage for adolescents in the United States remains well below that of other vaccines recommended by the Advisory Committee on Immunization Practices. In 2018, only 51.1% of adolescents 13-17 years of age were up-to-date and only 68.1% had even initiated the series. In the same year, coverage for the tetanus and reduced diphtheria toxoids and acellular pertussis vaccine (Tdap) and the quadrivalent meningococcal conjugate vaccine (MCV4) were 98% and 86.6% respectively. This suboptimal coverage is due to many factors including varied access to health care and general vaccine hesitancy. However, little is known about the impact of fragmented care on immunization coverage. We compared HPV vaccine series initiation and completion proportions for adolescents as a function of the number of providers and types of facilities where they received immunization services using provider-verified vaccination data and parental self-report of vaccination practices from the 2017 National Immunization Survey-Teen. Adolescents with two or more providers were less likely to initiate (7% absolute reduction) or complete (10% absolute reduction) HPV vaccination compared to adolescents with one provider. Adolescents receiving vaccines in hospital settings had higher HPV immunization coverage (69% initiation, 55% completion) compared to those vaccinated in other types of medical facilities (e.g. public – 64%, 46%; private – 66%, 52%). When the number of providers and the facility type are considered together these differences are compounded, leading to large variations in coverage. These results support the recommendation for children to maintain a medical home, as those with this type of consistent care seem to have the best vaccination coverage, while also enhancing support for vaccination services for children without a singular medical home. A focus on consistent care within a medical home, preventive visits, coordination across health entities and targeted interventions at the facility level could improve HPV vaccination coverage across the United States and provide better protection against HPV-related cancers.

Table of Contents

Chapter 1. Background and Literature Review p.1

Chapter 2. Manuscript p.11

Chapter 3. Public Health Implications and Future Directions p.48

Chapter 4. Appendices p. 51

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