Patient education key to improving HPV vaccination rates

LAS VEGAS – Misconceptions about the human papillomavirus (HPV) vaccine are responsible for low levels of use among young women, but education will help improve vaccination rates, according to a  researcher at the American Academy of Nurse Practitioners 26th Annual NP meeting.

“Education can go a long way,” said Kim Gould, DNP, RN, FNP-BC, of the Center for Women in Cottonwood, Arizona. “We need to let NPs know they can make a big impact, because we're the ones seeing these patients. We should ask every patient to discuss their HPV vaccination status.”

More than 11,500 U.S. women are newly diagnosed with cervical cancer and 4,000 die each year, Gould said. An estimated 25,000 additional HPV-related cancers, including vaginal, vulvar, anal, rectal, penile and oropharyngeal tumors are diagnosed in the U.S. each year, she added.

“There's a lot of rectal cancer too, but people don't realize that's also an HPV-related disease,” Gould said.

High-risk HPV strains 16 and 18, which are in included in both the quadrivalent HPV vaccine (Gaurdasil, Merck) and the bivalent vaccine (Cervarix, GlaxoSmithKline), are responsible for 70% of cervical cancers. Currently, the Advisory Committee on Immunization Practices (ACIP) recommends routine HPV vaccination for girls aged 11 and 12 years, and “catch-up” immunization for girls and women aged 13 to 26 years.

But nationwide, only 11% of women between the ages of 19 and 26 years have been vaccinated against HPV infection.

At Gould's clinic, HPV vaccination rates were even lower at 7%, but face-to-face education about HPV's risks proved too time consuming, she said.  So she developed a 10-minute educational video explaining the risks of HPV infection and the benefits of condom use and vaccination.

“I produced a video using information from the CDC and American Cancer Society,” Gould said.

In September and November 2010, she asked 51 of her patients aged 18 to 26 years to take a pretest and watch the video. Six weeks later, she e-mailed the patients a follow-up post-test using the Survey Monkey website.

All but five of her patients completed the post-test. “The results were remarkable,” Gould said. “A total of 45% of the patients who watched the video initiated HPV vaccination – up from 7%,” she said.

Through this advocacy program, Gould learned that education is a two-way street. “My patients are all so used to e-mail and YouTube, they were giving me advice about [how to improve] the video,” she said.

And there were additional benefits. The number of patients who reported using condoms 100% of the time more than doubled after viewing the video, from 7% to 18.7% at the six-week follow-up mark.

The full three-dose HPV vaccine series costs about $360 in Gould's practice, posing a significant barrier for those most at risk – low-income Hispanic and African-American women in whom HPV infection is overrepresented, Gould said. For these patients Gardasil manufacturer Merck offers rebates, Gould advised.

But there are other barriers in addition to education and cost. “The anti-vaccine lobby has created fear that vaccinating young girls will encourage them to engage in sexual behavior,” Gould noted. “And of course it is a new vaccine and there are unknowns, which is a valid concern.”

However, other than a few anecdotal cases of Guillain–Barré syndrome (GBS), adverse reactions beyond common pain and redness at the injection site have not been seen, Gould said.

Patients should be offered the opportunity to start their HPV vaccination series during their visit to the clinic, Gould emphasized, and not referred to a pharmacy to purchase the vaccine and come back later and have it administered. “Studies show that if patients walk out the door, far fewer of them will actually be vaccinated,” she said.

Gould reported no conflicts of interest.

Gould K. “Increasing Human Papillomavirus (HPV) vaccination in young women.” Presented at: 26th Annual American Academy of Nurse Practitioners Conference, 2011: Las Vegas, Nevada.

Bryant Furlow is a medical writer and award-winning investigative healthcare journalist based in Albuquerque, New Mexico.

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