Abstract PO-273: Human papillomavirus vaccination: California state-level mapping to identify gaps and inform practice and policy
Authors: Adler Jaime , Arias Raquel , Ashing Kimlin Tam , Davis-Patterson Shauntay , Gillette-Walch Hilary , Klausner Jeffrey , Knox Jim , Mitchell Beverly , Ogden-Smith Autumn , Pezua Jane , Singhal Rita , Su Hoa 
Published: December 2020

Abstract
Background: The human papillomavirus (HPV) virus is a known pathogen and carcinogen causing deadly cancers of the genitalia and head and neck. The HPV vaccine is a safe, effective cancer-preventing vaccine recommended for girls and boys at ages 11-12. Full HPV vaccine coverage is available through health insurance plans and the state of California, yet no data were readily available to describe California state-wide coverage of HPV vaccination. The Data Workgroup of the California HPV Vaccination Roundtable aimed to map State-level HPV vaccine coverage. Methods: Workgroup collected, analyzed, and mapped 2018 HPV vaccination data from the NIS-T survey, quality performance metrics from public and private health plans, and the statewide CAIR. NIS-T provides state-level estimates of routine adolescent vaccines, including HPV. Performance data were obtained from Medi-Cal and commercial health plans, administrative claims, and medical records.
CAIR contains individual-level, provider-reported immunizations. HPV vaccination coverage for adolescents were estimated at the state and county level. Maps of county-level HPV vaccination and HPV-related cancer rates were built. Results: Rates of HPV-related cancers ranged from 6-12 per 100,000. Regarding HPV vaccination, there were considerable variation in the metrics and limitations of each data source, therefore estimates are not easily comparable. CAIR estimates of HPV vaccination coverage (28%) are lower than those for Medi-Cal managed care (45%) and commercial HMO members (50%). In 2018, aggregated results showed that overall 50% of 13 year old were vaccinated. We observed in the CAIR data that boys and girls are vaccinated at similar rates. However, significant county/regional HPV vaccination rates exist ranging from 9% (rural, northern) to 55% (urban, western).
Northern, rural country have both the lowest HPV vaccination completion rates for 13-year-olds (9%), and the highest HPV-attributable cancer rates in the state (12 cases per 100,000 persons. Race/ethnic variations exist for HPV vaccination and HPV- related cancers–especially cervical cancer. Conclusions: This state-level data report approach may facilitate practice and policy action and help other states in developing their own reports for HPV vaccine improvements. Stakeholders are encouraged to utilize this Report when planning HPV vaccination interventions. We recommend that health systems: 1) assess HPV vaccination rates for 13-year-olds, 2) establish data exchange with CAIR, 3) implement recommended strategies to improve coverage, 4) collaborate with health plans and clinicians and 5) partner with community advocacy groups and clinic/hospital parent/patient advisory groups to improve data accuracy, as well as reduce HPV vaccine hesitance and promote at least 80% HPV vaccination completion by 2026.
Citation Format: Jaime Adler, Raquel Arias, Kimlin Tam Ashing, Shauntay Davis-Patterson, Hilary Gillette-Walch, Jeffrey Klausner, Jim Knox, Beverly Mitchell, Autumn Ogden-Smith, Jane Pezua, Rita Singhal, Hoa Su. Human papillomavirus vaccination: California state-level mapping to identify gaps and inform practice and policy [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-273.