Predictors of three dose on-time compliance with HPV4 vaccination in a disadvantaged, underserved, safety net population in the US Midwest.

HPV4 is approved as a series of three timed doses expected to result in efficacy against specific HPV infections. Completion rates in the US are quite low at the same time the structure of health care delivery is changing. The aim of this study was to determine how the patient-, clinic- and systems-level characteristics facilitate or hinder the timely completion of three HPV4 doses in both adolescent and adult female populations in a high-risk safety net population.This is a retrospective study in which patient-, clinic- and systems-level data are abstracted from the electronic medical record (EMR) for all females 10-26 years of age receiving at least one dose of HPV4 between July 1, 2006 and October 1, 2009.Adults were more likely to complete the three dose series if they had at least one health care visit in addition to their HPV4 visit, (aOR = 1.54 (95% CI:1.10, 2.15). Adults were less likely to complete the three dose series if they received their second HPV4 dose at an acute health care, preventive care or postpartum visits compared to an HPV4-only visit (aOR = 0.31 (95% CI: 0.13, 0.72), 0.12 (0.04, 0.35), 0.30 (0.14, 0.62), respectively). Hispanic adults were less likely than whites to complete the series (aOR = 0.24 (95% CI:0.10, 0.59). 39% of adolescents who completed two doses completed the series.HPV4 is more likely to be effectively administered to adults in a safety net population if multiple health care needs can be met within the health care system

Clinic- and Systems-Level Characteristics for Each HPV4 Dose.

*<p>Other vaccines given at the same time as HPV4 include TDaP, Td, Hep A, HepA/HepB combination, seasonal flu vaccine, meningitis (MCV4), MMR, pneumococcal vaccine, or varicella virus vaccine.</p>†<p>Birth control includes oral contraceptive pills, OrthoEvra® patch, Nuvaring®, or Depo-Provera® injection.</p>‡<p>Prescriptions include 35 classes of pharmacy dispensed prescriptions in all forms (injectable, oral, suppository, topical, or inhaler) and other vaccines received at the visit, excluding HPV4 vaccination.</p><p>CI means confidence intervals.</p

Descriptors of the Vaccinated Population.

†<p>There were no 9 year olds who received HPV4 in this study. The demographics of the 10–13 year olds were highlighted from the adolescent age group patient-level characteristics because they are a broad CDC target group for HPV vaccination.</p>*<p>Documented at any time prior to the first HPV4 dose.</p

Predictors of On Time Series Completion by Patient-, Clinic- and Systems-Level Characteristics.

*<p>Among women with two or more doses and with complete data. Appropriate dosing interval means: the interval between dose 1 and dose 2≥4 weeks but ≤26 weeks, and the interval between dose 2 and dose 3≥12 weeks, and the interval between dose 1 and dose 3≥24 weeks but ≤52 weeks.</p>§<p>Adjusted for significant variables in the univariate model.</p>§§<p>Variable was not significant in the univariate model.</p>†<p>Visit at which the first dose of HPV4 was initiated.</p><p>Bold font indicates Odds Ratios are statistically significant compared to referent.</p

Timely Series Completion by Visit Type at Each HPV4 Dose.

*<p>Dosing intervals: dose 1–2≥4 weeks but ≤26 weeks; dose 2–3≥12 weeks; and dose 1–3≥24 weeks but ≤52 weeks.</p