Human papillomavirus vaccination practices among providers in Indian health service, tribal and urban Indian healthcare facilities.
OBJECTIVE
The human papillomavirus (HPV) vaccine is of particular importance in American Indian/Alaska Native women because of the higher rate of cervical cancer incidence compared to non-Hispanic white women. To better understand HPV vaccine knowledge, attitudes, and practices among providers working with American Indian/Alaska Native populations, we conducted a provider survey in Indian Health Service, Tribal and Urban Indian (I/T/U) facilities.


METHODS
During December 2009 and January 2010, we distributed an on-line survey to providers working in I/T/U facilities. We also conducted semistructured interviews with a subset of providers.


RESULTS
There were 268 surveys and 51 provider interviews completed. Providers were more likely to administer vaccine to 13-18-year-olds (96%) than to other recommended age groups (89% to 11-12-year-olds and 64% to 19-26-year-olds). Perceived barriers to HPV vaccination for 9-18-year-olds included parental safety and moral/religious concerns. Funding was the main barrier for 19-26-year-olds. Overall, providers were very knowledgeable about HPV, although nearly half of all providers and most obstetricians/gynecologists thought that a pregnancy test should precede vaccination. Sixty-four percent of providers of patients receiving the vaccine do not routinely discuss the importance of cervical cancer screening.


CONCLUSIONS
Recommendations for HPV vaccination have been broadly implemented in I/T/U settings. Vaccination barriers identified by I/T/U providers are similar to those reported in other provider surveys. Provider education efforts should stress that pregnancy testing is not needed before vaccination and the importance of communicating the need for continued cervical cancer screening.
Immunization Services Division, Program Operations Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. cheyenne.jim@ihs.gov
Cheyenne C
CC
Jim
Jennifer Wai-Yin
JW
Lee
Amy V
AV
Groom
David K
DK
Espey
Mona
M
Saraiya
Steve
S
Holve
Ann
A
Bullock
Jean
J
Howe
Judith
J
Thierry
D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D005260:Female; D006268:Health Facilities; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D007194:India; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D011247:Pregnancy; D014481:United States; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*
D053918:Papillomavirus Vaccines