A postpartum human papillomavirus (HPV) vaccination program was locally implemented to address low initiation rates among young adults. Within 20 months, the program achieved high vaccine initiation and series completion rates. Based on the program’s success, it was expanded to all 36 counties served by a public hospital.
To conduct a quantitative and qualitative evaluation to examine the success and limitations of the program when expanded from 1 county to 36 counties, many of which are home to rural and medically underserved communities.
Patient navigators reviewed the electronic medical records and immunization registry records of women < 26 years of age, who delivered an infant at the public hospital, to determine whether they needed to initiate or complete the human papillomavirus vaccine series. Eligible women were counseled and offered the human papillomavirus vaccine during their hospital stay. Patient navigators scheduled follow-up injections in conjunction with the mother's postpartum or her infant's well-child visits, made reminder phone calls, and rescheduled missed appointments. Descriptive statistics, including frequencies and proportions, were used for patients approached in the initial and expansion programs. Frequencies from the initial and expansion programs were examined separately. Qualitative interviews were conducted with clinic staff to evaluate the program. The qualitative analyses were conducted using NVIVO version 10.
Both initial and expanded programs achieved vaccine completion rates over 70%. Out of the 2631 eligible postpartum women enrolled in the initial program, 785 (30%) had already been fully vaccinated. Of the remaining 1846 women, 1265 (69%) women received their 1 dose and 196 (11%) women received their 2 or 3 dose on the postpartum unit. Of the 1461 women who received at least 1 dose through the initial program, 1124 (77%) completed all 3 doses. Of the 4,330 eligible postpartum women enrolled in the expanded program, 886 (21%) had already been fully vaccinated. Of the remaining 3,444 women, 2284 (66%) received their 1 dose and 343 (10%) received their 2 or 3 dose on the postpartum unit. Of the 2627 women receiving at least 1 dose through the expanded program, 1932 (74%) completed all 3 doses. Clinic staff interviewed felt the program benefitted the postpartum unit and clinics, as it increased patient knowledge of the vaccine, increased patient volume for vaccination, and gave providers more time to focus on other tasks.
Human papillomavirus vaccination on the postpartum unit is an effective way to increase catch-up rates and is well-accepted by providers. High completion rates can be achieved if adequate support is provided, even among patients residing in rural or underserved areas who need extensive support to access primary healthcare services. Although this particular program may be considered costly, it is overall effective because the vaccine prevents 5 different types of cancer in women. The inclusion of human papillomavirus vaccination in routine postpartum care is a relatively easy way to reach many adults not vaccinated at a younger age and could help address low vaccination rates among young women in the US, including hard-to-reach populations.

Copyright © 2020. Published by Elsevier Inc.