title: Human papillomavirus vaccine practices in the USA: do primary care providers use sexual history and cervical cancer screening results to make HPV vaccine recommendations?
abstract: OBJECTIVE
  Guidelines recommend against the use of Papanicolaou (Pap) or human papillomavirus (HPV) testing when determining eligibility for the HPV vaccine. Optimally, the HPV vaccine should be administered before sexual initiation. Guidelines recommend that age-eligible women with past exposure to HPV should still be vaccinated. Little is known about how primary care providers (PCPs) use sexual history and HPV and Pap tests in their HPV vaccine recommendations.
  
  
  METHODS
  Data from the 2007 Cervical Cancer Screening Supplement (CCSS) administered with the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to assess HPV vaccination recommendations. The CCSS investigates cervical cancer screening practices, HPV testing and HPV vaccine recommendations among PCPs. A summary measure of compliance with guidelines was defined as rarely or never using the number of sexual partners and HPV tests and Pap tests to determine vaccine receipt. A total of 421 PCPs completed the CCSS in 2007.
  
  
  RESULTS
  Among NAMCS and NHAMCS providers who recommend the HPV vaccine, only 53% (95% CI 42% to 63%) reported making guideline-consistent recommendations. The majority reported sometimes to always recommending the HPV vaccine to women with a history of an abnormal Pap result (85%; 95% CI 75% to 91%) and a positive HPV test (79%; 95% CI 70% to 86%).
  
  
  CONCLUSIONS
  A large proportion of providers report practices that are inconsistent with guidelines. Providers may also be recommending the vaccine to women who may receive little benefit from the vaccine. Provider and system-level efforts to improve guideline-consistent practices are needed.
authors.affiliation: Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Room 4017, 6130 Executive Boulevard, MSC 7344, Bethesda, MD 20892-7344, USA. deanna.kepka@nih.gov
authors.forename: Deanna
authors.initials: D
authors.lastname: Kepka
authors.forename: Zahava
authors.initials: Z
authors.lastname: Berkowitz
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.forename: Katherine
authors.initials: K
authors.lastname: Roland
authors.forename: Mona
authors.initials: M
authors.lastname: Saraiya
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D011320:Primary Health Care / Q000379:methods*; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines