title: Availability of human papillomavirus vaccine at medical practices in an area with elevated rates of cervical cancer.
abstract: OBJECTIVE
  To assess availability of human papillomavirus (HPV) vaccine at medical practices in an area with elevated cervical cancer rates.
  
  
  METHODS
  During July-November 2007, we conducted a telephone survey of staff at medical practices providing outpatient care to 9- to 26-year-old females in four North Carolina counties with elevated cervical cancer rates. We assessed availability of HPV vaccine and concerns about its provision.
  
  
  RESULTS
  Staff from 71 of 96 eligible practices completed a full interview. Overall, 62% of these practices had HPV vaccine available to patients (family practice, 74%; pediatrics, 75%; obstetrics-gynecology, 64%; internal medicine, 15%). In multivariate analysis, practice characteristics that independently predicted a lower likelihood of carrying HPV vaccine were having at least 50% African-American patient population (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.06-0.63) and providing only privately purchased (and no state-supplied) vaccines (OR 0.19, 95% CI 0.06-0.63). HPV vaccine nonproviders were significantly more likely than HPV vaccine providers to report "large" concerns about the up-front costs of purchasing HPV vaccine (52% vs. 27%, p < .05) and late reimbursement (33% vs. 14%, p < .05).
  
  
  CONCLUSIONS
  Approximately 1 year after its introduction, HPV vaccine was available at three-quarters of family practice and pediatrics practices, two-thirds of obstetrics-gynecology practices, and few internal medicine practices in an area with elevated cervical cancer rates. Practices' concerns about cost and reimbursement have implications for accessibility of HPV vaccine to those who need it most.
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. sgottlieb@cdc.gov
authors.forename: Sami L
authors.initials: SL
authors.lastname: Gottlieb
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
authors.forename: Katie M
authors.initials: KM
authors.lastname: Keating
authors.forename: Lauri E
authors.initials: LE
authors.lastname: Markowitz
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D005260:Female; D019538:Health Care Surveys; D006268:Health Facilities; D006801:Humans; D008511:Medicine; D009657:North Carolina / Q000453:epidemiology; D053918:Papillomavirus Vaccines / Q000600:supply & distribution*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D053918:Papillomavirus Vaccines