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Integrating HPV Vaccination Within PrEP care Delivery for Underserved Populations: A Mixed Methods Feasibility Study

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Abstract

Human Papillomavirus (HPV) vaccination is effective at preventing anal cancer, which disproportionally impacts gay/bisexual men (GBM) and transgender women (TGW). Vaccine coverage among GBM/TGW is insufficient to reduce anal cancer disparities. Federally qualified health centers (FQHCs) can increase reach and uptake of HPV vaccination by integrating and promoting HPV vaccination in ongoing HIV preventive care (e.g., Pre-exposure Prophylaxis [PrEP]). The purpose of the current study was to assess the feasibility and potential impact of integrating HPV vaccination with PrEP care. We conducted a mixed methods study of PrEP providers and staff (qualitative interviews, N = 9) and PrEP patients (quantitative survey, N = 88) at an FQHC in Philadelphia, Pennsylvania. Qualitative thematic analysis of PrEP provider/staff interviews was informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify and describe barriers and facilitators to HPV vaccination implementation. Quantitative analysis of PrEP patient survey was informed by the Information-Motivation-Behavioral Skills Model. Quantitative interviews resulted in 16 themes related to characteristics of the inner and outer clinic context. Barriers among providers included lack of focus on HPV in PrEP management guidelines, in metrics mandated by funding agencies, and in electronic medical record templates. Lack of anal cancer specific knowledge and motivation was identified in both PrEP patients and providers/staff. Providing HPV vaccination during routine PrEP visits was highly acceptable to both patients and providers. Based on these findings, we recommend several multi-level strategies to increase HPV vaccine uptake among PrEP patients.

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Funding

This project was supported by TUFCCC/HC Regional Comprehensive Cancer Health Disparity Partnership, Award Number U54 CA221704(5) from the National Cancer Institute of National Institutes of Health (NCI/NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCI/NIH.

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Authors and Affiliations

  1. Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA

    Christopher W. Wheldon, Sarah Bauerle Bass & Bradley N. Collins

  2. Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS, USA

    Kevin J. Sykes

  3. Department of Population Health, University of Kansas School of Medicine, University of Kansas Cancer Center, Kansas City, KS, USA

    Megha Ramaswamy

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  1. Christopher W. Wheldon
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  2. Kevin J. Sykes
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  4. Sarah Bauerle Bass
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  5. Bradley N. Collins
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Contributions

Drs. Wheldon, Collins, and Bass contributed to the study conception and design, material preparation and data collection. Data analyses were performed by Dr. Wheldon in consultation with Dr. Bass. Drs. Ramaswamy and Sykes assisted with validation of the qualitative findings. All authors contributed to the interpretation of findings. The first draft of the manuscript was written by Dr. Wheldon, and all authors commented on several versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Christopher W. Wheldon.

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All study protocols were approved by the Temple University and Philadelphia FIGHT Institutional Review Boards.

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Wheldon, C.W., Sykes, K.J., Ramaswamy, M. et al. Integrating HPV Vaccination Within PrEP care Delivery for Underserved Populations: A Mixed Methods Feasibility Study. J Community Health 48, 640–651 (2023). https://doi.org/10.1007/s10900-023-01202-y

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