Abstract 721: Vaccination barriers for HPV vaccine initiation and completion: A perception analysis using the Association of Immunization Managers annual survey
Authors: Mercado-Andino Alondra Katerina , Suárez-Pérez Erick L. , Díaz-Miranda Olga L. , Medina-Labees Diana T. , Ortiz Ana P. , Wells Katelyn , Colón-López Vivian 
Published: April 2023

Abstract
Background: Human Papillomavirus (HPV) is the most common sexually transmitted infection in the United States of America (USA) and it is associated with six types of cancers. Vaccines that protect against HPV infection have been introduced since 2006. Despite many national efforts, vaccination rates remain under 80% and many individual and systematic barriers influence HPV vaccine uptake and completion. Addressing the stem of these barriers at a national level and their regional differences, will help in understanding necessary policies for the acceptance of HPV vaccine.
Objective: This study aims to describe the frequency of immunization program managers’ perceptions of the most relevant barriers to HPV vaccination in each national jurisdiction.
Methods: Immunization Program Managers (IPMs) in the USA were surveyed from August 2021 to February 2022 as part of the Implementation of School-Entry Policies for Papilloma Virus Vaccination (HPV-PIVac) study with the collaboration of the Association of Immunization Managers. We gathered IPMs perceptions on the most relevant barriers to HPV vaccination within their jurisdiction. Four vaccine barriers were evaluated; for each one, IPMs reported the level (moderate, significant, no barrier) in a three-item scale. The three-item scale was merged into a two-item scale (low/high) and multiple answers from the same state were grouped. Descriptive analysis was performed for each question and results were mapped. Fisher’s exact test was performed to determine the relation between barriers. IPMs that refused or didn’t know their jurisdiction’s barriers were removed from the analysis.
Results: 49 IPMs from 31 states and territories participated, resulting in a 53.4% participation rate. For the cost barrier to complete HPV vaccination of children, most IPMs perceived low barriers (51.7%) within their jurisdiction. For the perception of geographical difficulties to complete HPV vaccination, higher barriers (67.9%) were reported among participants. Limited number of providers offering the HPV vaccine was perceived equally as low or high level (50.0%), whereas lack of a strong provider recommendation or failure of providers to discuss and strongly recommend the HPV vaccine was the most significant barrier with a higher level (96.7%). Fisher’s exact test indicated independency between all barriers (p&gt;0.05). For most variables, the Western region reported a greater level of barriers.
Conclusion: This analysis documents the IPMs perception of prevalent HPV vaccine barriers for vaccine initiation and completion nationally. These results confirmed the need of further engagement for the accessibility of the vaccine, as preliminary data from NIS-Teen 2021 shows an average adolescent HPV vaccine initiation and UTD coverage of 78.2 and 62.7, respectfully.
Funding: NCI Grant #R01CA232743
Citation Format: Alondra Katerina Mercado-Andino, Erick L. Suárez-Pérez, Olga L. Díaz-Miranda, Diana T. Medina-Labees, Ana P. Ortiz, Katelyn Wells, Vivian Colón-López. Vaccination barriers for HPV vaccine initiation and completion: A perception analysis using the Association of Immunization Managers annual survey [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 721.