title: Primary care providers human papillomavirus vaccine recommendations for the medically underserved: a pilot study in U.S. Federally Qualified Health Centers.
abstract: BACKGROUND
  In the United States, Federally Qualified Health Centers (FQHCs) are safety-net clinics that provide cervical cancer screening and human papillomavirus (HPV) vaccination to medically underserved women, some of whom may be at risk for developing cervical cancer. National guidelines recommend against using screening test results or sexual history to determine vaccine eligibility. Documenting HPV vaccine recommendations and beliefs of primary care providers in FQHCs may aid in promoting evidence-based practices and prioritizing health interventions for vulnerable populations.
  
  
  METHODS
  Between 2009 and 2010, we collected data from 98 primary care providers in 15 FQHC clinics in IL, USA using a cross-sectional survey. Questions assessed provider and practice characteristics, HPV vaccine recommendations, and provider's belief about whether their screening and management procedures would change for women who were vaccinated.
  
  
  RESULTS
  93% of providers recommended the HPV vaccine, most frequently for females aged 13-26 years (98%). Some providers reported sometimes to always using HPV test results (12%), Pap test results (7%), and number of sexual partners (33%) to determine vaccine eligibility. More than half of providers (55%) reported they will not change their screening and management practices for vaccinated females, yet believe vaccination will yield fewer abnormal Pap tests (71%) and referrals for colposcopy (74%).
  
  
  CONCLUSIONS
  Study providers routinely recommended the HPV vaccine for their patients. However, providers made fewer recommendations to vaccinate females ages 9-12 years (which includes the target age for vaccination) compared to older females, and used pre-vaccination assessments not recommended by U.S. guidelines, such as screening test results and number of sexual partners. In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer, adherence to guidelines is necessary, especially in settings that provide care to medically underserved women.
authors.affiliation: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341, USA. Electronic address: kroland@cdc.gov.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Roland
authors.affiliation: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341, USA.
authors.forename: Vicki B
authors.initials: VB
authors.lastname: Benard
authors.affiliation: Battelle, Health & Analytics, 1100 Dexter Ave N, Suite 400, Seattle, WA 98109, USA.
authors.forename: April
authors.initials: A
authors.lastname: Greek
authors.affiliation: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341, USA.
authors.forename: Nikki A
authors.initials: NA
authors.lastname: Hawkins
authors.affiliation: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341, USA.
authors.forename: Mona
authors.initials: M
authors.lastname: Saraiya
mesh_terms: D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007087:Illinois; D008297:Male; D008507:Medically Underserved Area; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D058007:Physicians, Primary Care; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer screening; Federally Qualified Health Center (FQHC); HPV vaccine; Low-income; Underserved