Barriers to HPV Vaccination in
Women with Cervical dysplasia
Cheng Tou MD; Michael Podolsky MD
Drexel COM /Department of OB/GYN
Introduction
Results
Conclusions
Human papillomavirus (HPV) is the most
common sexually transmitted infection in the
US. Nearly 80% of adults, will be exposed to
HPV in their lives. High risk types are
associated with the majority of diagnosed
cervical cancers.
Among the 434 women who submitted surveys, 301 of these women who had submitted surveys fit the study
criteria established. The demographic factors of these patient can be seen in Table 1.
While widespread availability of HPV
vaccination has made HPV prevention a
tangible possibility, the rates of vaccination
continue to be below desired levels. From
our study, it is clear that women presenting
with cervical dysplasia often run into
obstacles to HPV vaccination. The majority of
women in our colposcopy clinic, women who
are already at increased risk for cervical
dysplasia, reflect the national trends of under
– and unvaccinated women.
Table 1
Of the 301 eligible women, 190 of these women were
less than 26yo. And 111 from 26 to 31yo. In our analysis,
there was no statistical significance found between any
of these demographic factors and vaccination (Table 1).
Over the last decade, HPV vaccination has
become an important public health measure.
In spite of this, the rates of HPV vaccination
remain suboptimal.
The purpose of our study is to evaluate
patient desire for vaccination as well as
demographic and patient-identified factors
that contribute to barriers to vaccination.
Materials and methods
This is an observational cohort study of
women from the Drexel College of Medicine
Colposcopy Clinic. Inclusion criteria included
voluntary participation of women with known
cervical dysplasia from ages 21 to 31yo.
Women who chose to participate were
provided with a survey asking for patient
information regarding date of birth and day of
visit. Demographic information was then
gathered separately from this information.
Women were also asked in this survey to
report history of HPV vaccination and
number of doses for those who had. in
women who had not received vaccination,
women were asked to choose from several
factors, including an area to self report
unlisted reasons, which they perceived to be
barriers to HPV vaccination.
Fig 1. HPV Vaccination Rates in Colposcopy Clinic
Among the reasons provided, there was no
single predominant barrier to HPV vaccination
(Table 2). However, the most commonly
reported reason was “My provider had not told
me about it” with 17.9% reporting this. Lack of
health insurance coverage as well as “Other”
(most commonly reported by women as being
“Too old”) were also reported as common
reasons for not receiving HPV vaccination.
Table 2
References
CDC. 2012. Human Papillomavirus Epidemiology and Prevention of Vaccine
Preventable Disease. The Pink Book (12th Ed).
CDC/MMWR. 2014. HPV: Recommendations on the ACIP. 63(5); 1-30.
Ostor AG. 1993. Natural History of Cervical Intraepithelial Neoplasia: A
Critical Review. Int J Gyn Path. 12(2):186-192.
The FUTURE II Study Group. Quadrivalent vaccine against human
and ideally prior to coitarche.
As can be seen by Figure 1, the majority of our
population, 79% was unvaccinated at the time of clinical
encounter. Of the remaining 21% who reported HPV
vaccination, only a small percentage of the total survey
population (9%) had completed a full HPV vaccination
series with the remaining (12%) reporting incomplete
vaccination. In spite of the overwhelming number of
unvaccinated women, 58% of unvaccinated women
expressed interest in vaccination.
Acknowledgments
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Niccolai LM, Mehta NR, Hadler JL. 2011. Racial/Ethnic and Poverty
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Provider influence plays a pivotal role in
patient decision making. In our population,
the lack of counseling by patients’ provider
was the most commonly reported reason for
not receiving HPV vaccination. As
practitioners, concentrated efforts should be
made to encourage women to receive
vaccination especially prior to HPV infection
Special thanks to my
faculty advisor Dr. Michael
Podolsky, the Drexel Colposcopy Clinic, and
the Drexel COM Department of OB/Gyn
In our population we did not find an
association between demographic factors
such as age, race, insurance coverage,
obstetric, or sexual history. The association
between such factors in the past has been
difficult to evaluate due to confounding
factors. In our population, no correlation was
found between these factors and vaccination
however, we did not set out to correct for
these factors
Future Research
It is our hope that this study will lead to
further study and implementation of
measures such as provider training that
would help increase rates of HPV vaccination
in our population.