Initiating Human Papillomavirus Vaccination at Age 9: Strategies for Success From 5 US Health Systems

Objective: The study objective was to explore how health systems have successfully initiated human papillomavirus (HPV) vaccination routinely at age 9 with the goal of sharing best practices with health systems nationwide. The ultimate goal is to increase HPV vaccination rates to address the persistent high prevalence of HPV resulting from suboptimal vaccination, with strong interest and support for vaccination initiation at age 9. Methods: Guided by the Consolidated Framework for Implementation Research, a mixed methods study was conducted in 5 US health systems using surveys and interviews to learn about best practices associated with successful HPV vaccination initiation among 9-year-old children. Survey responses were quantified and summarized. Content and rapid qualitative analysis along with data reduction methods were applied to summarize content from the interviews and extract common themes. Results: A total of 497 surveys were completed and 10 interviews were conducted at 5 geographically and structurally diverse US health systems. Participants included pediatricians, nurses, clinic managers, quality and population health leaders, and immunization strategists. Successful interventions identified included sharing data on vaccination rates, obtaining leadership and staff buy-in/ownership, electronic health record updates and education/training for providers and staff, and early preparation and education for patients and families. Conclusions: Programs to initiate HPV vaccination at age 9 can be successfully implemented in US health systems by identifying and addressing barriers and utilizing multitiered interventions at the patient/family, provider/staff, and organization levels.