Implementation Outcomes from an Expansion of the All for Them HPV Vaccination Initiative
Introduction
The HPV vaccine can protect youth from acquiring nine types of HPV that cause anogenital and oropharyngeal cancers, as well as genital warts. Although 2018 series completion rates for the City of Houston (50.9%) and Tarrant County (45.9%) are higher than the series completion rate for Texas (39.7%), these HPV vaccination rates are still well below the Healthy People 2030 goal of 80% completion. Completion rates in these priority populations are even lower, at 15.6% or less. All for Them is a theory-driven multilevel, multicomponent program comprising three synergistic evidence-based strategies to effectively increase HPV vaccine initiation and completion rates among middle and high school students living in medically underserved areas in Texas. Strategies include a social marketing and educational campaign, comprehensive school-based vaccination clinics, and HPV vaccination-focused school nurse education. This poster focuses on implementation outcomes from the social marketing and vaccination clinic strategies.
Methods
From 2020-2023, All for Them implementation expanded from one urban school district to six diverse suburban and urban school districts in the greater Houston and Fort Worth, Texas communities. Priority populations expanded from middle-school only to high schools in two districts. Social marketing messaging approaches were revised to reach parents of teens and teens ages 18 or older who can consent to HPV vaccine for themselves. Outreach strategies covered several methods, including social media paid and organic content, printed materials delivered directly to parents, and community awareness tactics. Free, pre-consented comprehensive vaccination clinics offered all childhood and adolescent vaccines and were primarily designed to serve as a safety net for students who do not have access to vaccines. Therefore, a majority of students receive vaccines with their primary providers, but campaign messaging can impact all audiences. Offering the vaccination to high school students old enough to consent for themselves provides these youth with an opportunity to advocate for their own healthcare.
Results
Implementation outcomes comprised both individual and community level metrics. In partnership with five mobile healthcare providers, the All for Them team conducted 190 comprehensive vaccination clinics at 72 public middle and high schools (between 6-26 schools per district) and community locations. A total of 4,100 youth received one or more vaccines at the clinics (a small percentage of these youth received multiple vaccines across project years). Of these youth, 2,669 received a dose of HPV vaccine (1,812 [68%] initiation, 823 [31%] completion, 27 [1%] interim doses). Parental acceptance rate for youth needing HPV vaccine was 96%. Across the three years of the project, we: (1) distributed 104,492 consent packets and clinic awareness flyers, (2) mailed 57,042 postcards, (3) had direct educational interactions with 16,760 parents and students, (4) distributed 2,239 HPV vaccine next-dose reminder cards to facilitate series completion, and (5) generated 3,378,899 social media impressions.
Conclusion
The All for Them strategies work together synergistically to address challenges associated with increasing HPV vaccine uptake in medically underserved communities. Social marketing strategies increase parents’ knowledge and awareness of the HPV vaccine and reinforce it as a vital part of standard adolescent healthcare. Comprehensive vaccination clinics provide safety-net access to HPV and other necessary vaccinations by reducing logistic barriers. Continuing nurse education (not discussed here) increases nurse self-efficacy to communicate effectively with parents and make strong recommendations for HPV vaccination. The expansion of All for Them to new communities and populations across Texas is a promising approach to improve HPV vaccination uptake for youth living in MUAs.