Energizing and equipping rural providers in Washington state to increase HPV vaccination of preteens, ages 9-12 - July 2024
By Sherri Zorn, MD, FAAP, and DeAnna Pittenger, RN, BSN-CPN
Vaccination partners in Washington State are dedicated to preventing HPV cancers by increasing HPV vaccination of preteens aged 9-12 with a particular focus on reducing disparities in rural communities and for non-English speakers.
As part of this effort, the Washington Chapter of the American Academy of Pediatrics developed the “HPV@9” Multi-level Quality Improvement Project to support streamlined workflows for HPV vaccination starting at age 9 and to help healthcare providers give a strong announcement recommendation using a cancer prevention message. Strong collaboration with Washington State Department of Health facilitated simplified coverage rate data collection through Washington’s Immunization Information System (known as WAIIS) and the development of multiple supportive HPV education materials, many of which have been translated into the top spoken languages in Washington, including Spanish, Russian, and Chinese as a few examples. The Washington State Department of Health website dedicated to starting HPV vaccination at age 9 is available here.
The project includes webinars, printed materials, posters, data reviews, and expert coaching. Participating physicians receive Maintenance of Certification (MOC), part 4 credit, and the webinars are accredited for continuing education CME/CE hours.
Webinars review rural HPV disparities (i.e. higher HPV cancer rates and lower HPV vaccination rates), introduce the rationale for starting HPV vaccination at age 9, how to use the announcement approach, and how to address HPV vaccine hesitancy. WCAAP provides printed training materials for staff and providers, namely the HPV Cue Card and the Announcement Approach Tool, and two sets of posters for exam rooms. The first poster features a diverse representation of preteens and a simple message that HPV vaccination is cancer prevention for all kids, starting at age 9. The second poster is a simplified, parent-friendly vaccination schedule featuring HPV starting at age 9. Seventy-one percent of surveyed providers rate the vaccination schedule poster as extremely helpful and providers comment that both posters do a great job introducing and normalizing the HPV vaccine recommendation.
The first cohort in early 2023 was comprised of five pediatric and family medicine clinics serving rural communities in Washington. The timing of cohort 1 coincided with a change in WAIIS forecast for HPV vaccination, with HPV now due at age 9 and overdue at age 13. To date, over 30 Washington clinics have successfully participated in the project, with two-thirds of the clinics serving rural communities.
After one year, cohort 1’s median HPV initiation coverage rate at age 9-10 years increased by 26 percentage points (from 1 to 27%), and the median HPV initiation coverage rate at age 11-12 years increased by 4 percentage points (from 49 to 53%). Fifty percent of surveyed providers indicated that recommending HPV at age 9-10 was somewhat (41%) or much (9%) easier than recommending it at age 11-12 and only 8% indicated that it was harder.
Clinic and physician leaders expressed appreciation, commenting that the project was easy to implement and was well received by most staff and providers: “Keep rolling it out, very effective” and “Proud to be preventing cancer!”
One rural pediatrician shared “This has been an eye-opening experience and a big surprise that parents are welcoming of HPV at age 9/10”.
Dr. Sherri Zorn, MD, FAAP, is a Pediatrician and Quality Improvement Coach.
DeAnna Dudley Pittenger, RN, BSN-CPN, is a Registered Nurse and Quality Improvement Program Manager, Washington Chapter of the American Academy of Pediatrics (WCAAP)
