Human Papillomavirus (HPV) is the most common sexually transmitted infection currently affecting nearly 80 million people in the United States. Southern states have disproportionately high incidence rates of HPV-related cancers; Arkansas has the highest incidence rate (14.4 per 100,000) in the US. Vaccines exist to protect against the cancer-causing strains of HPV and are recommended for all children beginning at age 11, but vaccination rates remain low. Vaccines For Children (VFC) is a program administered by the Centers for Disease Control and Prevention (CDC) that provides free vaccines to providers for administration to children at no charge. All children under age 18 and enrolled in Medicaid or uninsured are eligible. Despite the strong reach potential afforded by access to free vaccines, participation in the South is low; only 4% of Arkansas physicians are VFC providers and local health departments are the sole resource of VFC vaccines for 20 of 75 Arkansas counties. To improve the reach potential of the VFC program (and thereby HPV vaccination) in the Southern US, this application will explore the use of community pharmacies as HPV vaccination sites. Community pharmacies are highly accessible when compared to ?traditional? vaccination sites due to their extended hours in evening and on weekends, no copays for visits, and no requirement to schedule an appointment to speak with a pharmacist. Pharmacists can administer vaccines to children aged 7 and older as long as certain requirements are met, all of which include physician oversight. This application proposes a variety of potential ?collaboration models? which can be utilized by pharmacists and physicians interested in providing more HPV vaccines. One example is a ?shared responsibility model? in which the first dose of the vaccine is administered in the physician's office while the second dose is administered in the pharmacy. This study will use implementation science to determine and pilot-test a promising vaccine-delivery partnership model between pharmacists and physicians and an array of supportive implementation strategies to support uptake and sustainability of HPV vaccine provision in the community pharmacy setting. The following specific aims are proposed:
Aim 1) Identify barriers and facilitators to community pharmacies' provision of HPV vaccine through a mixed methods design with pharmacy staff members and local physicians;
Aim 2) Select a pharmacist-physician collaborative model and identify implementation strategies through an Evidence Based Quality Improvement (EBQI) process with key stakeholders;
and Aim 3) Pilot the selected pharmacist- physician collaborative model and implementation strategies in two pharmacies (1 rural, 1 urban) and evaluate on relevant implementation outcomes. The long term goal of this project is to improve HPV vaccination rates among adolescents in the US, especially in rural and underserved areas. Results from this study will provide the foundation for a large cluster-randomized implementation trial that will include multiple community pharmacy contexts ? large and small, urban and rural, and chain- and independently-operated.

Public Health Relevance

This pilot study aims to utilize implementation science methods to: 1) conduct a developmental formative evaluation of potential barriers and facilitators associated with increasing HPV vaccinations in community pharmacies, 2) design a partnership model between physicians and pharmacists and determine implementation strategies through a collaborative process known as Evidence Based Quality Improvement, and 3) evaluate the model and strategies by measuring relevant implementation outcomes. The pilot of the partnership model and implementation strategies will take place over a period of one year with an opportunity to adapt and modify after 6 months. The ultimate goal of this application is develop care coordination between physicians and pharmacists to improve HPV vaccination rates among adolescents ? especially those who live in rural, underserved areas where immunization providers are scarce.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Dissemination and Implementation Research in Health Study Section (DIRH)
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Kobrin, Sarah
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University of Arkansas for Medical Sciences
Schools of Pharmacy
Little Rock
United States
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