Effectiveness of a School- and Primary Care–Based HPV Vaccination Intervention

Author:

Thilly Nathalie12,Michel Morgane34,Simon Maïa12,Bocquier Aurélie1,Gagneux-Brunon Amandine567,Gauchet Aurélie8,Gilberg Serge9,Le Duc-Banaszuk Anne-Sophie10,Bruel Sébastien1112,Mueller Judith E.1314,Giraudeau Bruno1516,Chevreul Karine34, ,Agrinier Nelly17,Adam Isabelle17,Bonnay Stéphanie17,Fall Estelle17,Pulcini Céline17,Ecollan Marie17,Hagiu Dragos-Paul17,Le Bel Josselin17,Partouche Henri17,Pinot Juliette17,Rossignol Louise17,Tron Arthur17,Zuo Minghui17,Vareilles Gaëlle17,Bros Julie17,Juneau Catherine17,Branchereau Marion17,Botelho-Nevers Elisabeth17,Jambon Géraldine17,Jeanleboeuf Florian17,Kalecinski Julie17,Lasset Christine17,Marie Dit Asse Laetitia17,Sicsic Jonathan17,Raude Jocelyn17,Chyderiotis Sandra17,Oudin-Doglioni Damien17,Dussault Josée17,Barret Anne-Sophie17,Bonmarin Isabelle17,Levy-Bruhl Daniel17,Castagnet Clémence17,Simony Mélanie17,Ailloud Julien17,Epaulard Olivier17,Darlington Emily17,Nekaa Mabrouk17

Affiliation:

1. Université de Lorraine, APEMAC, Nancy, France

2. Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, Nancy, France

3. Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France

4. Unité d’épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France

5. CIC-1408 Vaccinologie, CHU de Saint-Etienne, Saint-Priest-en-Jarez, France

6. Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, Lyon, France

7. Institut Presage Chaire Prevacci, Université Jean Monnet, Saint-Priest-en-Jarez, France

8. Université Savoie Mont Blanc, Université Grenoble Alpes, LIP/PC2S, Grenoble, France

9. Department of General Practice, Université Paris Cité, Paris, France

10. Centre Régional de Coordination des Dépistages des cancers-Pays de la Loire, Angers, France

11. Department of General Practice, Jacques Lisfranc Faculty of Medicine, Université Saint-Etienne-Lyon, Saint-Etienne, France

12. Health, Systemic, Process UR 4129 Research Unit, Université Claude Bernard Lyon 1, Lyon, France

13. Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France

14. Université de Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Rennes, France

15. Université de Tours, Université de Nantes, SPHERE U1246, Inserm, Tours, France

16. Inserm CIC 1415, CHRU de Tours, Tours, France

17. for the PrevHPV Study Group

Abstract

ImportanceThe human papillomavirus (HPV) vaccine is safe and effective, yet vaccination coverage remains below public health objectives in many countries.ObjectiveTo examine the effectiveness of a 3-component intervention on HPV vaccination coverage among adolescents aged 11 to 14 years 2 months after the intervention ended, each component being applied alone or in combination.Design, Setting, and ParticipantsA cluster randomized trial with incomplete factorial design (PrevHPV) was conducted between July 1, 2021, and April 30, 2022, in French municipalities receiving 0, 1, 2, or 3 components of the intervention. Randomization was stratified by school district and municipalities’ socioeconomic level. Analyses were carried out on 11- to 14-year-old adolescents living in all participating municipalities, regardless of what had been implemented.InterventionThe PrevHPV intervention had 3 components: (1) educating and motivating 11- to 14-year-old adolescents in middle schools, along with their parents; (2) training general practitioners (GPs) on up-to-date HPV information and motivational interviewing techniques; and (3) free HPV vaccination at school.Main Outcomes and MeasuresThe primary outcome was HPV vaccination coverage (≥1 dose) 2 months after the intervention ended among 11- to 14-year-old adolescents living in participating municipalities, based on the French national reimbursement database and data collected during the trial in groups randomized to implement at-school vaccination.ResultsA total of 91 municipalities comprising 30 739 adolescents aged 11 to 14 years (15 876 boys and 14 863 girls) were included and analyzed. Half the municipalities were in the 2 lowest socioeconomic quintiles and access to GPs was poor in more than two-thirds of the municipalities. Thirty-eight of 61 schools (62.3%) implemented actions and 26 of 45 municipalities (57.8%) had at least 1 trained GP. The median vaccination coverage increased by 4.0 percentage points (IQR, 2.0-7.3 percentage points) to 14.2 percentage points (IQR, 9.1-17.3 percentage points) at 2 months. At-school vaccination significantly increased vaccination coverage (5.50 percentage points [95% CI, 3.13-7.88 percentage points]) while no effect was observed for adolescents’ education and motivation (−0.08 percentage points [95% CI, −2.54 to 2.39 percentage points]) and GPs’ training (−1.46 percentage points [95% CI, −3.44 to 0.53 percentage points]). Subgroup analyses found a significant interaction between at-school vaccination and access to GPs, with a higher effect when access was poor (8.62 percentage points [95% CI, 5.37-11.86 percentage points] vs 2.13 percentage points [95% CI, −1.25 to 5.50 percentage points]; P = .007 for interaction).Conclusions and RelevanceIn this cluster randomized trial, within the context of the late COVID-19 pandemic period and limited school and GP participation, at-school HPV vaccination significantly increased vaccination coverage. The trial did not show a significant effect for training GPs and education and motivation, although it may be observed after more time has elapsed after the intervention.Trial RegistrationClinicalTrials.gov Identifier: NCT04945655

Publisher

American Medical Association (AMA)

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