According to the National Cervical Cancer Coalition, nearly 13,000 women in the United States are diagnosed with cervical cancer each year. Fortunately, with vaccinations and screenings (i.e., Pap and HPV tests), the disease is essentially preventable. To celebrate Cervical Health Awareness Month, and in recognition of the critical role vaccination, NACCHO checked in with two of our HPV Prevention Project demonstration sites to see how they are promoting HPV immunization in adolescents to support cervical health in their communities.
The below Q&A shares insights from Houston Health Department’s LaTasha Hinckson Callis, MBA, Administration Manager, and Sean Dade, MPA, Management Analyst IV, as well as Central District Health Department’s Heather Gagliano, RN, Immunization Program Manager.
Q: What challenges has your local health department (LHD) historically faced with HPV immunization?
Houston Health Department (HHD): While we know the HPV vaccine is highly effective in preventing cancers caused by the human papillomavirus, there are definitely challenges we face in Houston regarding HPV vaccination. HPV is contracted through intimate skin-to skin- contact and therefore, the vaccine is often associated solely with sexual activity and not cancer prevention. Scientific studies have shown no correlation between the HPV vaccine and increased sexual activity, but this often comes up as a parental concern. The need for additional education and training for physicians and their staff on how to respond to vaccine-hesitant parents is a necessity. This will ensure a confident medical community that can promote HPV vaccine consistently for adolescents, the same way as with the Tdap and Meningitis vaccines.
In addition, service delivery is another common challenge with HPV vaccine uptake. Similar to national trends, the coverage rate in Houston for the first dose of HPV vaccine is relatively high, with rates declining when assessing third dose completion. Despite the challenges, we consistently promote the use of evidence-based strategies among providers (e.g., reminder/recall, bundled recommendations, and HPV Champions) to increase HPV vaccination rates.
Central District Health Department (CDHD): We have seen similar challenges, but have also run into internal obstacles. For example, we experienced a major downsizing of our Immunization Department about six years ago. Even though staff continued to immunize, rates among teens were consistently low. But in 2014, CDHD’s Immunization Department integrated services with the Reproductive Health Program during a walk-in Teen Clinic held every Thursday. Integration allowed our clients to become more connected with other health department services and assisted wit staffing issues.
Further, as health professionals and care providers, we knew the benefits of vaccination well, but needed to figure out why vaccination was important from the community’s perspective. To help answer that question, we collaborated with Boise State University students who produced a Photo Voice piece that featured parents sharing why immunizations mattered in their lives. The piece captured reasons ranging from specific-disease prevention (e.g., HPV, seasonal flu) to general protection of their children’s future. Ultimately, what we perceived at the time as a challenging transition period actually allowed us to realize some unexpected advantages.
Q: As part of NACCHO’s HPV Immunization Project, what activities is your LHD engaged in to increase HPV vaccination rates in your jurisdiction?
HHD: As part of NACCHO’s HPV Project, the Houston Health Department (HHD) hosted a strategic planning meeting (June 2016) with immunization stakeholders across Houston. The following four project activities were established to increase HPV coverage rates over the subsequent three years: ¹Bridging educational efforts, ²Engaging partners, ³Implementing evidence-based strategies and ⁴Developing motivational strategies. In September 2016, HHD was awarded additional grant funds from the Centers for Disease Control and Prevention (CDC) to support an increase in the quality and implementation of adolescent Assessment Feedback Incentive and eXchange (AFIX) visits over the next two years.
In addition, HHD collaborated with the Immunization Coalition of Greater Houston (ICOGH) to form an HPV Workgroup within the organization. The objective of the Workgroup is to coordinate initiatives to educate Houstonians on the importance of HPV vaccination. In honor of National Cervical Cancer Awareness Month (January 2016), the Workgroup has launched a communication initiative of four, 5-7 minute PSA radio announcements focusing on HPV vaccine as cancer prevention.
CDHD: We partnered with the Idaho Health and Wellness Collaborative for Children to develop a learning collaborative for adolescent immunizations statewide. The group met monthly and held a kickoff event in February 2016. Soon thereafter, another group of external partners gathered and formed the HPV Free ID Steering Committee. With permission, the group adapted the same format used by Nevada’s HPV FREE NV campaign. The goal of the group was to move forward in a joint effort to host an HPV Summit on February 2, 2017 and an HPV Vaccination Day on February 9, 2017.
The goal of the HPV Summit is to bring everyone together in the state to learn about and focus on the disease and myths that surround HPV. Leading up to the events, the group has planned digital and radio ads for the general public, specifically for parents of 11-12 year old adolescents. In addition, the movie Someone You Love will be available for viewing at the end of the summit. The statewide “HPV Vaccination Day” aims to encourage healthcare providers in Central District to allow walk-in HPV vaccinations on that day.To promote the event, we developed a “Save the Date” mailer, stakeholder toolkit, and HPV Free ID website.
Q: How have the latest HPV vaccination recommendations impacted your work, and how do you plan to adjust your project work to better align with the recommendations?
HHD: The new 2-dose HPV recommendation has positively impacted the number of adolescents who are now fully vaccinated and protected against HPV. HHD is scheduling in-person and webinar-based trainings for Texas Vaccines for Children (TVFC) Program Providers that will include guidance on how to effectively communicate the two-dose recommendation to their patients. In addition, we are in the process of identifying the number of the patients seen in our Houston Health Department health centers that are fully vaccinated due to the new recommendation. Parents of these adolescents will receive a letter informing them of their child’s up-to-date status.
CDHD: Fortunately, most of our materials emphasized completing the vaccine series, rather than explicating focusing on the number of vaccinations; this saved us from having to modify, reprint, and redistribute everything. Still, we recognized the importance of sharing this information and have done so via email and handouts at partner meetings, such as the Adolescent Immunization Learning Collaborative. We will continue to socialize the new recommendations at our project events, including HPV Summit in February 2017.
Q: What has been your project’s biggest success so far, and how do you plan to keep the momentum?
HHD: Along with the CDC grant award, our biggest success was our HPV Improvement Project. We utilized the Texas Immunization Registry, ImmTrac, to identify 574 patients that were delinquent on completing the HPV vaccine series and had visited HHD Health Centers. We utilized community partnerships and resources to engage 43% of those patients through phone calls, home visits and school-located vaccination clinics. Of those patients engaged, 79% completed their HPV vaccine series, while the remaining received HPV education. With the additional CDC funding, we are increasing the number of TVFC Provider offices we visit while improving the quality of our AFIX assessments, creating a video to be distributed among providers, and implementing innovative activities such as HPV report cards and recognition in our new newsletter to spotlight the high performers. Moving forward, we will utilize webinar services to promote peer-to-peer training while exploring the possibility of offering Continuing Education Credits to nurses and physicians for other educational activities. These combined efforts will allow us to continue striving for improvement in HPV vaccination rates across Houston.
CDHD: Our biggest success has been our ability to destigmatize the HPV vaccine and educate teens. Our HPV rate among teens when we first integrated our Immunization Program with the Reproductive Health Program was 38%. After education and explanation about the vaccine, our rates are now up to 85%, which represents 900 teens after just a year and a half. Moving forward, we’re working toward an internal strategic goal to prevent cases and outbreaks of vaccine-preventable diseases. By June 2020, we want 85% of all 14- to 18-year-olds receiving CDHD services and attending other offsite clinical events to be up-to-date and late up-to-date on ACIP recommended immunizations.
NACCHO commends all of our HPV Prevention Project sites for the excellent work they are doing to increase HPV vaccination rates in their communities and decrease adolescent risk for developing cancers, including cervical cancer, later in life. To help your LHD promote cervical health awareness through the remainder of January and beyond, the below resources are available:
- Visit the National Cervical Cancer Coalition website for sample social media posts, free downloadable content (e.g., factsheets, posters, ebooks), podcasts, videos, and a provider toolkit.
- Check out CDC’s new Vaccines & Immunizations website for resources for immunization partners and healthcare providers.
- View NACCHO’s Guide to HPV Resources for Local Health Departments.