Dr. Sheth is an obstetrician and gynecologist whose long-term goal is to optimize the implementation of evidence-based recommendations for prevention of gynecologic cancers. The proposed training and mentored research experience will enable her to achieve her short-term goals of developing expertise in conducting dissemination and implementation (D&I) research on human papillomavirus (HPV) vaccine and of using qualitative methods and medical informatics as research tools. Dr. Sheth has assembled an expert and committed team of mentors and advisors to help her. Dr. Linda Niccolai (primary mentor) is a recognized leader in HPV vaccine research and qualitative methods and Dr. Steven Bernstein (co-mentor) is an expert in D&I research for cancer prevention. Dr. Sheth will complete a certificate program in D&I science through UCSF, take advanced courses at Yale on qualitative methods, clinical informatics and the design and conduct of clinical trials, and complete a course on the design of health IT tools through Oregon Health and Science University. Each year in the U.S., HPV causes approximately 330,000 cases of precancerous cervical dysplasia, and 12,000 cases of cervical cancer. Since 2006, FDA-approved HPV vaccines have been available. Immunization is recommended routinely for all 11-12 year olds, and as catch-up immunization through age 26 years. However, uptake of HPV vaccine in the U.S. is poor: overall, only 43% of adolescents are fully immunized. Sustained efforts for catch-up immunization are critical to address missed opportunities to protect women against HPV-associated diseases. Even among women who have been sexually active before immunization, a substantial burden of disease can be prevented, especially since the current vaccine protects against 9 different HPV types responsible for >80% of cervical cancers. One strategy to improve HPV immunization rates is to vaccinate postpartum women during their hospitalization when there is easy access to patients. This would also reduce the number of visits needed to complete the multi-dose series. Several other vaccines (Tdap, influenza, MMR) have been integrated into postpartum hospital care for catch-up immunization, but not so the HPV vaccine.
We aim to promote integration of inpatient postpartum HPV immunization (IPP-HPV) into routine care by developing an electronic medical record (EMR)-based tool modeled on current practices used for other vaccines administered during inpatient postpartum care and on stakeholder preferences. We will evaluate the feasibility of using the EMR-based tool as an implementation strategy for achieving high fidelity and sustainability of IPP- HPV immunization. This study will help inform development of an implementation toolkit for IPP-HPV immunization to use in a subsequent full-scale hybrid implementation and effectiveness trial. Upon completion of this award, Dr. Sheth will have expertise in D&I science research methods. She will have established the groundwork for conducting future studies to translate IPP-HPV immunization into a national model and will be well poised to become an independent clinician-scientist.
Although HPV vaccines to prevent anogenital and oropharyngeal cancers have been available since 2006, vaccine uptake in the U.S. is poor: overall, only 49% of adolescent girls are fully immunized. Sustained efforts for catch-up vaccination are critical to address missed opportunities to protect women against HPV- associated diseases. In this study, we will study the integration of one targeted immunization strategy, inpatient postpartum HPV (IPP-HPV) immunization, into routine care by developing an electronic medical record-based tool utilizing a user-centered, iterative approach, and evaluating the feasibility of using the tool as an implementation strategy for achieving high fidelity and sustainability of IPP-HPV immunization.
