Abstract IA020: Adaptation of provider and staff targeted evidence-based interventions in safety-net settings to achieve equitable HPV vaccination
Authors: Tsui Jennifer , Garcia Samantha , Shin Michelle B. , Sloan Kylie , Dang Emily , Baezconde-Garbanati Lourdes , Palinkas Lawrence , Crabtree Benjamin F. 
Published: December 2023

Abstract
Implementation science, conducted through a health equity lens and participatory stakeholder-engaged approach, can inform how to best to adapt and sustain interventions within safety-net settings (e.g., federally qualified health centers, hospital-affiliated clinics, county health systems reaching medically underserved communities) to achieve long-term cancer health equity. The current challenge in implementation science and cancer health equity is not a lack of knowledge about what works for cancer prevention and control improvement, but how to integrate, adapt and sustain effective evidence-based strategies (EBS) and tools into local community and clinic contexts where they are needed most. As an example, HPV vaccination rates remain below target levels among adolescents in the United States, which is particularly concerning in medically underserved with persistent disparities in HPV-associated cancer burden. There are numerous evidence-based strategies designed to improve HPV vaccination, but few are routinely used, much less sustained in safety-net settings. Significant disruptions due to the COVID-19 pandemic further support the need to understand implementation context and processes for implementation needs of EBS for HPV vaccination in safety-net clinics. This educational session presentation focuses on how to advance adaptation and fit of EBS for HPV vaccination improvement in diverse contexts and settings for medically underserved populations with the broader goal of addressing cancer health equity through implementation science. We share our work in understanding the perspectives of stakeholders serving diverse communities in an NCI-funded HPV vaccine implementation study. We demonstrate the need for EBS and implementation processes to be tailored to the local context, community needs, and engaged with key clinic leadership and implementors throughout. From the multi-site FQHC demonstration phase of our study, we assess ongoing adaptation of EBS (provider trainings, clinic staff education, workflow assessment, and audit and feedback) and implementation processes at multiple levels (broader system, individual clinic sites, providers and staff). We also systematically integrate relevant structural and social determinants into interventions to meet the needs of diverse communities. Adaptation to clinical contexts as well as current HPV vaccination content (e.g. age 9, addressing vaccine hesitancy, community-specific concerns) are necessary to maximize fit and sustainability. Findings from these examples can inform adaptation requirements of implementing evidence-based strategies to address cancer health equity for other cancer sites and cancer prevention targets. Further, this educational session informs a broader understanding of resources and processes needed to sustain EBS for HPV vaccination over time and research needs within the intersection of implementation science and cancer health equity.
Citation Format: Jennifer Tsui, Samantha Garcia, Michelle B. Shin, Kylie Sloan, Emily Dang, Lourdes Baezconde-Garbanati, Lawrence Palinkas, Benjamin F. Crabtree. Adaptation of provider and staff targeted evidence-based interventions in safety-net settings to achieve equitable HPV vaccination [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA020.