Provider perspectives on systems-level barriers to HPV vaccine uptake among people living with HIV (PLWH) in the HPV vaccine catch-up age range

Authors: Muthukrishnan M, Loux T, Shacham E, Arnold LD

Category: Behavioral Science & Health Communication
Conference Year: 2020

Abstract Body:
Purpose: To identify provider and clinic-level characteristics that impact HPV vaccine recommendations for PLWH aged 18-26 years. Methods: In this ongoing mixed methods study, healthcare providers who provide care for PLWH were recruited from the IDSA discussion forum (3/18/19-10/21/19) to complete an online survey (n=48) and interviews (n=11) about clinic barriers/facilitators of HPV vaccine recommendation. Descriptive statistics examined barriers/facilitators reported in the surveys, and interviews were analyzed for themes. Results: Preliminary survey results found all providers used an EHR system in their clinic , but only 16.7% used it to identify HPV vaccine eligible patients. Only 14.6% reported having clinic guidelines/policies for HPV vaccination. Most (72.9%) reported scheduling subsequent HPV vaccine doses at the current visit, and 45.8% provided literature for their patients to read. Other procedures to encourage HPV vaccine uptake were not as widely used, i.e. reminder cards for initial dose (6.3%) or next dose (17.0%), mailed patient reminders for initial dose (0%) or next dose (4.2%), using a flowchart to identify items to cover during patient visits (12.5%), EHR prompted reminders (16.7%), flagging eligible unvaccinated patients' charts (14.6%), phone call reminders for next doses (20.8%), and noting medical history responses to decide whether to recommend the vaccine (21.3%). This pattern was reflected in the interviews, with themes of provider uncertainty regarding clinic policies or lack of clinic policies to maximize HPV vaccination in PLWH 18-26yrs. Providers noted that an automated EHR prompt to identify an unvaccinated patient would help increase HPV vaccine conversations, instead of having to search the EHR themselves. Conclusions: Because provider recommendation is the strongest predictor of HPV vaccine uptake, identifying provider- and clinic-level barriers and facilitators to HPV vaccine uptake provides opportunities to inform the development of targeted interventions. Several underutilized strategies identified by providers may inform interventions to increase HPV recommendation and uptake PLWH in the catch-up vaccine range, ultimately reducing the burden of HPV-related cancers among these high-risk individuals.

Keywords: HPV vaccine, barriers, provider recommendation