What interventions are most effective at increasing the Human Papillomavirus vaccination rates for adolescents in a school-based vaccination delivery program?

<p dir="ltr"><b>Aim: </b>To determine what interventions are most effective in increasing the rates of Human Papillomavirus (HPV) vaccination for adolescents in a school-based vaccination delivery program (SBVP).</p><p dir="ltr"><b>Background: </b>HPV is responsible for 630,000 diagnoses each year and is implicated in nearly all squamous cell carcinomas of the reproductive tract, anus, head, and neck cancers. It is also responsible for 90% of cervical cancers. The HPV vaccine available to reduce the consequences of this disease and that is currently delivered as a two-dose schedule to 11–12- year-olds via a school-based delivery program in most parts of New Zealand, is, however, not reaching enough adolescents to meet national or global targets. This suboptimal uptake is putting our adolescent population at risk of infection and related cancers. Further guidance for health professionals responsible for delivering the HPV vaccination to adolescents in the SBVP is therefore needed to increase the vaccination uptake rate.</p><p dir="ltr"><b>Design: </b>Integrative literature review</p><p dir="ltr"><b>Method: </b>Four electronic databases were systematically searched (CINAHL, MEDLINE, EMBASE, Cochrane Library), in addition to a hand search of the reference lists of studies meeting inclusion criteria relevant to the research question. No date restrictions were applied to the searches. Studies were limited to those published in the English language. The included studies were assessed for quality using the appropriate Cochrane risk of bias tool.</p><p dir="ltr"><b>Results: </b>Five studies met the inclusion criteria, one being a randomised controlled trial and the second being a cluster randomised controlled trial. Three of the studies measured the effectiveness of parent reminders on HPV vaccine uptake. Statistical significance was reported when reminders were given via text message (<i>p </i>value= 0.016), or phone call (OR 1.63, 1.09-2.42 95% CI). There was no statistical significance for the remaining two studies that measured the effectiveness of educational interventions on vaccine uptake (<i>p </i>value= 0.89), (Vaccine dose 1, <i>p </i>value= 0.47, dose 2, <i>p </i>value= 0.89, dose 3, <i>p </i>value=0.74). Two studies had a high risk of bias, two raised some concern for bias and one had a low risk of bias.</p><p dir="ltr"><b>Conclusion: </b>Reminder interventions aimed at parents were the most effective at increasing the HPV vaccination uptake rate amongst adolescents receiving the vaccine as part of an SBVP, and educational interventions were the least effective. Strong conclusions are, however, limited by the quality of the studies. Further well-designed randomised controlled trials measuring the effectiveness of differing interventions on the HPV vaccination uptake rate for adolescents in the school setting are therefore required, to allow more robust recommendations to be made.</p><p dir="ltr"><br></p>