SHORT REPORT Human papillomavirus vaccine practices in the USA: do primary care providers use sexual history and cervical cancer screening results to make HPV vaccine recommendations? Deanna Kepka, 1 Zahava Berkowitz, 2 K Robin Yabroff, 1 Katherine Roland, 2 Mona Saraiya 2 ABSTRACT Objectives Guidelines recommend against the use of Papanicolaou (Pap) or human papillomavirus (HPV) testing when determining eligibility for the HPV vaccine. Optimally, the HPV vaccine should be administered before sexual initiation. Guidelines recommend that age- eligible women with past exposure to HPV should still be vaccinated. Little is known about how primary care providers (PCPs) use sexual history and HPV and Pap tests in their HPV vaccine recommendations. Methods Data from the 2007 Cervical Cancer Screening Supplement (CCSS) administered with the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to assess HPV vaccination recommendations. The CCSS investigates cervical cancer screening practices, HPV testing and HPV vaccine recommendations among PCPs. A summary measure of compliance with guidelines was defined as rarely or never using the number of sexual partners and HPV tests and Pap tests to determine vaccine receipt. A total of 421 PCPs completed the CCSS in 2007. Results Among NAMCS and NHAMCS providers who recommend the HPV vaccine, only 53% (95% CI 42% to 63%) reported making guideline-consistent recommendations. The majority reported sometimes to always recommending the HPV vaccine to women with a history of an abnormal Pap result (85%; 95% CI 75% to 91%) and a positive HPV test (79%; 95% CI 70% to 86%). Conclusions A large proportion of providers report practices that are inconsistent with guidelines. Providers may also be recommending the vaccine to women who may receive little benefit from the vaccine. Provider and system-level efforts to improve guideline-consistent practices are needed. Differences among guidelines may impact primary care provider (PCP) knowledge and recommenda- tion practices for the human papillomavirus (HPV) vaccine. In 2006, the Advisory Committee on Immunization Practices (ACIP) recommended that girls aged 11 and 12 years receive the HPV vaccine and that girls and women aged 13e26 years who have not yet received the vaccine receive ‘catch up’ vaccination as part of cervical cancer prevention efforts to increase vaccine coverage in the USA. 1 Similarly, the American Cancer Society also recom- mends HPV vaccination for girls aged 11 and 12 years with ‘catch-up’ vaccination for girls and women aged 13e18 years. However, the American Cancer Society differs from ACIP and recommends that HPV vaccination should be a part of informed decisions between a patient and her provider for women aged 19e26 years due to insufficient evidence that assesses vaccine benefit among women with more than four sexual partners and the lack of cost-effectiveness analyses evidence for vaccination for this age group. 2 Optimally, the HPV vaccine should be administered before sexual initi- ation. However, ACIP and the American College of Obstetricians and Gynecologists recommend that age-eligible women with past exposure to HPV still be vaccinated (ie, regardless of whether they have an abnormal Papanicolaou (Pap) test or a positive HPV test). 34 Guidelines recommend against the use of Pap or HPV testing to identify women for HPV vaccination 4 and routine HPV testing for women under the age of 30 years. 56 Little is known about how PCPs use sexual history and HPV and Pap testing in their recommendations for the HPV vaccine. METHODS We used data from the 2007 Cervical Cancer Screening Supplement (CCSS) administered with the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to assess PCPs HPV vaccination recommendations for their patients. The CCSS investigates cervical cancer screening practices, HPV testing and HPV vaccine recommendations among PCPs. The questionnaire was administered in PCP offices and community health centres (NAMCS) and hospital outpatient departments (NHAMCS). NAMCS includes obste- tricians/gynaecologists, general/family practice physicians, internists or mid-level providers and has a large range of sociodemographic characteristics of these providers; NHAMCS includes clinics special- ising in obstetrics/gynaecology or general medicine and only has their geographical region of practice. 78 Descriptive statistics and HPV vaccine recom- mendations were assessed for 407 NAMCS and NHAMCS respondents who provided information on their cervical cancer screening practices. 7 Among providers who recommend the HPV vaccine and 1 Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA 2 Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Correspondence to Dr Deanna Kepka, Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Room 4017, 6130 Executive Boulevard, MSC 7344, Bethesda, MD 20892-7344, USA; deanna.kepka@nih.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Cancer Institute or the Centers for Disease Control and Prevention. Accepted 28 March 2012 Kepka D, Berkowitz Z, Yabroff KR, et al. Sex Transm Infect (2012). doi:10.1136/sextrans-2011-050437 1 of 3 Health services research STI Online First, published on April 21, 2012 as 10.1136/sextrans-2011-050437 Copyright Article author (or their employer) 2012. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on April 27, 2012 - Published by sti.bmj.com Downloaded from