title: A human papillomavirus vaccination program for low-income postpartum women.
abstract: Effective interventions are needed to address the low rate of human papillomavirus (HPV) vaccination in the United States, particularly among girls and women 16-26 years old. Counseling and offering the vaccine to postpartum patients could be an effective strategy to increase uptake among young women who did not complete the 3-dose series at an earlier age.
  
  
  
  The purpose of this evaluation was to assess the effectiveness of a multicomponent program designed for postpartum women that used patient navigators (PNs) and reminders for follow-up visits to improve uptake and completion of the HPV vaccine series.
  
  
  
  As part of standard care, patients ≤26 years of age from Galveston County, Texas, who delivered an infant from November 2012 through June 2014 at a public hospital were counseled and offered the HPV vaccine postpartum. PNs assisted with scheduling follow-up injections during postpartum or well-child visits. A program evaluation was conducted after 20 months.
  
  
  
  Of 1038 patients approached, only 161 (15.5%) had previously completed the vaccine series. Of the 877 patients who had not completed the series, 661 (75.4%) received at least 1 dose postpartum, with 575 patients receiving their first dose and 86 receiving their second or third doses. By April 2015, initiation rates had increased as a result of this program from 25.4% before the program was initiated to 80.8% and completion rates from 15.5-65.1%. Missed appointments for injections were less likely among those who received text message reminders and more likely among those with ≥2 prior pregnancies. Those who were Hispanic or had received an influenza vaccination in the last year were more likely to initiate and complete the series through this program. Patients who missed ≥1 follow-up appointments were less likely to complete the vaccine series.
  
  
  
  Offering the HPV vaccine postpartum dramatically increased initiation rates among postpartum patients. PN and text messages ensured that a high percentage completed all 3 doses.
authors.affiliation: Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX; Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX. Electronic address: abberens@utmb.edu.
authors.forename: Abbey B
authors.initials: AB
authors.lastname: Berenson
authors.affiliation: Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX; Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX.
authors.forename: Mahbubur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX; Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Hirth
authors.affiliation: Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rupp
authors.affiliation: Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX.
authors.forename: Kwabena O
authors.initials: KO
authors.lastname: Sarpong
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care; D049590:Postpartum Period; D011203:Poverty; D015397:Program Evaluation; D011634:Public Health; D013781:Texas; D060145:Text Messaging; D014481:United States; D014611:Vaccination; D016387:Women's Health; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: human papillomavirus; human papillomavirus vaccine; patient navigator; postpartum women; vaccine completion; vaccine initiation; vaccine uptake