Understanding Barriers to HPV Vaccination: Perspectives From Air Force Family Medicine Physicians and Active Duty Air Force Males
Authors: Halista Courtney E , Kline Randolph J , Bepko Jennifer 
Published: December 2019

Abstract

Introduction
Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. The Center for Disease Control Advisory Committee on Immunization Practices (ACIP) has recognized the potential benefits of immunizing young men beginning at age 11 or 12 years and continuing through age 21 years. The maximum age of immunization is extended through age 26 for men who have sex with men, transgender individuals, and immunocompromised men. In spite of these recommendations, vaccination of young men is currently limited by numerous patient and provider variables. The authors sought to delineate these variables as they pertain to members of the U.S. Air Force in order to guide future interventions.

Methods
The study consisted of two cross-sectional surveys at a single Air Force Base in California. The protocol was approved by the Institutional Review Board at David Grant Medical Center. The physician survey consisted of 10 questions that were formatted and designed to assess physicians’ knowledge about the quadrivalent HPV vaccine (Gardasil) and 6 questions that were formatted and designed to assess physicians’ counseling practices regarding Gardasil. The physician survey was distributed electronically via email in January 2017 to all 48 Family Medicine physicians, including both residents and staff, within the Family Medicine Residency Clinic at Travis Air Force Base. The email contained a link via Microsoft Share-point to an anonymous online survey. The patient survey was distributed in paper form to all male service members between the ages of 18 and 30 years who attended Commander’s Calls over a 90-day period between January 2017 and March 2017. The patient survey included the primary outcome: proportion of respondents who had completed the HPV vaccination series. Descriptive statistics, including frequencies and percentages, were used to summarize the data. Contingency tables were constructed and the chi-square test or Fisher’s Exact Test were performed to determine if particular demographic variables were associated with correct answers to individual knowledge questions.

Results
The majority of the Family Medicine physicians surveyed have adequate knowledge of HPV and the vaccine but do not routinely offer the vaccine to their male patients. Inadequate time during the office visit was cited as the major limitation to vaccine promotion. Of the Active Duty Air Force males surveyed, only 27% completed the vaccine series. A lack of knowledge regarding the personal benefits of the vaccine and failure to remember to receive subsequent doses were cited as barriers to completion. Only one-quarter of all surveyed males were interested in speaking with a healthcare provider about HPV and/or the HPV vaccine.

Conclusion
Deficiencies in public knowledge and insufficient provider practices are likely contributing to the suboptimal rates of HPV vaccination among eligible males. Additionally, eligible males are not interested in speaking with their healthcare providers about either HPV or the HPV vaccine. If the rates of HPV vaccination within the male population are to increase, health educators, public health proponents, and vaccine advocates need to devise a more effective approach to disseminate this information to eligible male recipients.