HPV Centralized R/R RCT #2 - New York State

The overarching goal is to evaluate the effectiveness, cost effectiveness, and sustainability of statewide immunization systems (IISs) to conduct reminder/recall (R/R) to improve human papillomarvirus (HPV) vaccination rates among adolescents ages 11-14.

Each year, 6.2 million persons are newly infected with HPV and 26,000 new HPV-related cervical, genital, and oropharyngeal cancers are diagnosed, resulting in >$4 billion in annual medical costs. Despite U.S. guidelines for vaccinating all adolescents starting at age 11 with the HPV vaccine, in 2012 only 53% of 13-17 year old females had >1 dose and 35% had 3 doses; 21% of teen males had a vaccination.

The most effective strategy for improving vaccination rates is patient reminder/recall (R/R). Recent literature from Melissa Stockwell found that utilization of a new R/R modality, i.e. text messaging, positively impacted influenza vaccination rates among the adolescents enrolled in the study. Although R/R is already considered a "best practice" for improving vaccination rates, very few practices use reminder/recall for any vaccinations because of costs and lack of personnel time; and even fewer use reminder/recall for HPV vaccine.

Furthermore, since the Advisory Committee on Immunization Practices (ACIP) modified the schedule for the HPV series for adolescents' age 11-14 years, those who receive dose #1 between ages of 11 and 14 years are now eligible for their second and final dose 6-12 months after their initial dose. This change in dosing schedule could influence HPV vaccine visit scheduling procedures within Family Practice and/or Pediatric Clinics, and would therefore effect timing and frequency of any R/R strategies currently in place. Therefore, the UCLA (overseeing the work to be done in NY) and University of Colorado at Denver research teams unite to understand how the use of centralized R/R to disseminate reminders, via text messages and autodialer calls, to patients eligible for the 2-dose HPV vaccine could impact vaccination rates among adolescents ages 11-14. This will be the first head-to-head RCT comparing text message vs. autodialer reminders to standard of care control

The aim of the study is as follows:

To assess the impact and cost-effectiveness of autodialer IIS R/R versus text message based IIS R/R versus standard-of-care control (no reminder recall) in increasing initiation and completion of the 2-dose HPV vaccine series among adolescents 11-14 years of age. The investigators will use a within-practice randomized control trial, randomizing patients within 150 practices to the aforementioned intervention arms.

Hypothesis 1: All centralized IIS R/R modalities will be more effective than usual care

Hypothesis 2: Text messaging will be more cost-effective than other modalities

Upon completion of the study, the investigators will have a feasible, sustainable, cost-effective model for HPV vaccination reminders that could be scaled up on the national level to help prevent HPV-related cancers. Additionally, this research will be adding significant new knowledge to the field as no such studies exist examining the impact of educational text message R/R on HPV vaccination rates among adolescents eligible for the 2-dose series.

Inclusion criteria

• 11 to 14 years of age
• patient of a participating practice in New York State (practices were randomly selected)
• is due for an HPV dose at baseline, or
• has initiated but not yet completed the HPV series at baseline
• immunization record within the New York State Immunization Information System (NYSIIS) database

Exclusion criteria

• is not a patient of a participating practice that was randomly selected in New York State
• has completed the HPV vaccination series
• does not have a valid record within the NYSIIS database