HPV Vax at 9: A Look at Rural Communities

Sherri Zorn, MD

This year, as part of WCAAP (Washington Chapter AAP), we received $25,000 in grant funding from AAP to develop an HPV Project for Rural communities. We developed a rapid quality improvement(QI) project (Feb-July 2023) for “HPV Vax at 9,” recruited 5 clinics serving rural communities in 5 Washington state counties, and awarded 25 MOC credits for participating providers. The start of this QI project coincided with a change in our state immunization registry to forecast for HPV due at age 9, and this official forecast change really helped get clinics interested knowing that they have support from WA DOH.

WCAAP’s first Cohort experienced such great success that we’re already midway through Cohort 2 with 8 additional clinics and 2 additional funders.  This project consists of two provider training webinars, clinic coaching, printed training tools, and posters for display in the exam rooms and lobbies. The two webinars cover the following topics:

  • Why HPV at 9
  • Using the Announcement Approach
  • How to implement HPV at 9 in the clinic
  • Understanding Rural HPV disparities, and
  • Overcoming HPV vaccine hesitancy.

Printed training materials include HPV Cue Cards and the Announcement Approach Pathway. Also supplied are two different posters for each clinic: the American Cancer Society “Protect your kids from cancer” poster (English/Spanish) and a Simplified Immunization Schedule poster (Clinics are able to choose from a custom poster that WCAAP creates to reflect their standard workflow, or one from WA DOH that is available in multiple languages).

Our biggest learnings: “HPV at 9” works in rural Washington.  Clinics can fully implement it and see almost immediate success in just a few months.  Age 9-10 HPV initiation coverage rates increased by 7-16 percentage points at each clinic in less than 5 months, with our goal being a 20 percentage point increase in 12 months. 

55% of providers found recommending at age 9-10 to be easier than at age 11-12, 36% found it to be about the same, 9% found it to be harder than at age 11-12.  Additionally, the Simplified Immunization Schedule poster is helping them with all their vaccine conversations (70% found it extremely useful, 27% found it somewhat useful). A few comments from providers:

  • “This has been an eye-opening experience and a big surprise that parents are welcoming of HPV at age 9/10”
  • “This has been a real win compared to the covid vaccine which was so contentious.”