title: Early lessons learned from extramural school programs that offer HPV vaccine.
abstract: BACKGROUND
  There has been little evaluation of school-located vaccination programs that offer human papillomavirus (HPV) vaccine in US schools without health centers (ie, extramural programs). This article summarizes lessons learned from such programs.
  
  
  METHODS
  In July to August 2010, 5 programs were identified. Semistructured, in-depth telephone interviews were conducted with program representatives about practical aspects of planning and implementation, including configuration and effectiveness.
  
  
  RESULTS
  Most programs offered HPV vaccine as part of a broader effort to increase uptake of adolescent vaccines. Respondents stressed the importance of building partnerships with local school systems throughout all aspects of the planning and implementation phases. All programs offered HPV vaccine at no cost to students. Most did not have a mechanism to bill private insurance, and some found Medicaid reimbursements to be a challenge. Programs achieved modest rates of initiation of the 3-dose HPV vaccine series (median 10%); however, among those who initiated the series, completion rates were high (median 78%). HPV vaccine uptake was lowest for a program that offered only HPV vaccine.
  
  
  CONCLUSIONS
  Extramural programs may increase uptake of vaccines and decrease absenteeism due to noncompliance with vaccine requirements for school entry. Until extramural programs in the US receive better access to billing private insurers and Medicaid, sustainability of these programs relies on grant funding. Better integration of extramural school-located vaccine programs with existing local healthcare and other programs at schools is an area for growth.
authors: Primary Prevention Research and Evaluation Program, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA. khayes@rti.org
authors: Kim A
authors: KA
authors: Hayes
authors: Pamela
authors: P
authors: Entzel
authors: Wendy
authors: W
authors: Berger
authors: Rachel N
authors: RN
authors: Caskey
authors: Judith C
authors: JC
authors: Shlay
authors: Brenda W
authors: BW
authors: Stubbs
authors: Jennifer S
authors: JS
authors: Smith
authors: Noel T
authors: NT
authors: Brewer
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D020380:Needs Assessment; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D016730:Program Development; D015397:Program Evaluation; D018570:Risk Assessment; D012572:School Health Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D014611:Vaccination / Q000379:methods
chemical_list: D053918:Papillomavirus Vaccines