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HPV Vaccine Toolkit: Increasing HPV Vaccine Uptake Among Adolescent Clients in the Family Planning Setting

Toolkit/Guide
Adolescent Services LGBT Services Male Services Related Preventive Health Services

HPV Vaccination

Human papillomavirus (HPV) can cause six different kinds of cancer—including cervical and oropharyngeal. The HPV vaccine, however, can prevent more than 90% of the cancers caused by HPV—an estimated 32,100 cases every year—from ever developing and save thousands of lives.

The HPV vaccine is recommended for routine vaccination at ages 11 or 12 years old; it can be administered to children as young as 9 years old, and catch-up HPV vaccination is recommended for all people through 26 years of age. Vaccination started before age 14 has been found to be most effective, and only requires two doses (versus three doses starting at age 15).

Increasing HPV vaccination of adolescents continues to be a top priority. Healthy People 2020 set the goal that 80% of adolescents be vaccinated for HPV. Currently, only 51% of adolescents across the nation have been vaccinated and are fully protected.

 

Illustration of a woman sitting on an exam table in a doctor's office.

This toolkit describes three approaches to increasing HPV vaccination—especially among adolescents— at a Title X-funded family planning site. Family planning sites can increase HPV vaccination by:

  1. Adding HPV vaccination to existing services
  2. Increasing the number of clients (especially adolescents) receiving the HPV vaccine
  3. Increasing and improving referrals for vaccination off-site

These approaches, along with suggested action steps and supportive resources, are described below. Tools and resources in this guide should be used in relation to your site’s needs and priorities.

 

The most direct way for a family planning site to increase HPV vaccination rates is to offer the vaccine. This approach includes first conducting background research into the site’s state rules, regulations, and third-party payer coverage of the vaccine. With this information, a site will be able to better determine the financial implications of adding HPV vaccination to existing services.

Strategy 1: Conduct research and understand regulatory context in which vaccines are provided.

Action Steps Supportive Resources

Provide free or reduced-fee vaccine services in accordance with Title X Program Requirements on how clients should be charged and Vaccines for Children (VFC) program.

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Strategy 2: Identify the potential costs and revenue associated with providing the HPV vaccine.

Action Steps Supportive Resources

Review current third-party payer contracts to determine if HPV vaccination is reimbursable. If not, renegotiate contracts as appropriate.

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Identify the expected cost of the vaccine, using the CDC Vaccine Price List.

Consider using Group Purchasing Organizations to obtain HPV vaccines at a reduced cost.

Develop an estimate of the potential volume, costs, and revenue associated with provision of HPV vaccination services.

 

HPV Vaccination Business Case Workbook

A family planning site that already offers HPV vaccination can become more efficient, thus increasing the number of clients getting vaccinated. This approach includes implementing three strategies, to be pursued simultaneously, that will help to ensure that all adolescents are vaccinated. The strategies are to 1) seize all opportunities to vaccinate; 2) maintain active immunization tracking; and 3) communicate effectively with clients and parents/guardians.

Strategy 1: Seize all opportunities to vaccinate.

Action Steps Supportive Resources

Train all staff on HPV vaccine guidelines, effectiveness, and safety. Include information about minimum intervals and contraindications.

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Post the ACIP U.S. immunization schedule (or that of a state health department) prominently in the office and all exam rooms.

Use all client encounters to assess need for—and provide—HPV and other vaccines. Use normalizing language to explain and administer multiple adolescent vaccinations, including the HPV vaccine, during one visit.

Using Normalizing Language to Encourage HPV Vaccination Among Adolescent Clients

Identify a designated immunization “champion” on staff to monitor HPV vaccination rates and keep clinical staff current on recommendations.

Establish a system to order the HPV vaccine, so that it is consistently available in your on-site inventory.

Establish a standardized workflow and standing orders for administering the HPV vaccine.

Develop a policy that allows for widespread access to vaccination. The policy should:

  • Offer vaccination-only visits during clinic hours (by appointment or walk-in)
  • Provide youth-friendly clinic hours (including evenings and/or weekends)
  • Comply with state requirements for parental consent
  • Allow vaccination after phone consent from a parent, if required

Strategy 2: Maintain active immunization tracking.

Action Steps Supportive Resources

Flag client’s medical file and/or EHR to indicate adolescent client is eligible to begin HPV vaccine and review client’s immunization record prior to visit.

Document the client’s vaccination status at all visits.

Ask new clients for previous immunization records and update their medical file/EHR accordingly.

Provide clients with immunization record cards.

Keep a log of clients who are due for dose 2 or 3 of the HPV vaccine. Whenever a HPV vaccine is not given, document this within their medical file/EHR and schedule a follow-up visit.

Strategy 3: Communicate effectively with clients and parents/guardians.

Action Steps Supportive Resources

Use normalizing language to explain the importance of getting the HPV vaccine to adolescent clients and their parents/guardians. Highlight for parents/guardians that HPV vaccination is cancer prevention.

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Using Normalizing Language to Encourage HPV Vaccination Among Adolescent Clients

Identify and address the parent/guardian/client’s specific concern about HPV vaccine (e.g., need for the HPV vaccine, safety, and efficacy).

Counseling Patients and Parents on the HPV Vaccine

Schedule the visit for the next dose before the client leaves the office.

Ask parents who refuse the HPV vaccine to sign a refusal form acknowledging the risks of not vaccinating and document the refusal in the client’s record. If vaccination is declined, recommend the HPV vaccine again at each future visit.

 

If the site has decided that offering the HPV vaccine is not feasible but remains committed to increasing HPV vaccination among adolescents, another strategy is to develop a referral system.

Strategy 1: Establish a referral system for HPV vaccination services.

Action Steps Supportive Resources

Expand the site’s existing referral system to include HPV vaccination providers.

Establishing and Providing Effective Referrals for Clients: A Toolkit for Family Planning Providers

Establish referral agreements (memoranda of understanding) with local HPV vaccination providers.

Sample MOU Template

Maintain contact information for local HPV vaccination providers.

Local Resource List

Train staff on how to make an effective referral.

 

Referral Quality Staff Observation Activity, Instructions, and Handouts