# Online Decision Support for Implementing Evidence-Based HPV Vaccination Strategies in Texas Safety-Net Pediatric Clinics: Impact on HPV, MCV, and Tdap Initiation

## TL;DR

An online tool helped Texas clinics improve HPV and other vaccine rates by supporting evidence-based strategies for adolescent immunization.

## Contribution

The AVP-IT online decision support tool successfully boosted HPV vaccination rates in underserved safety-net clinics.

## Key findings

- AVP-IT implementation led to an immediate increase in HPV vaccine initiation rates (p < 0.001).
- Long-term trends showed significant improvements for HPV, MCV4, and Tdap vaccines (p < 0.001).
- Vaccination rates for older youth aged 13–17 years showed longitudinal significance.

## Abstract

Introduction: HPV vaccination rates for adolescents in the United States are below recommended levels. The Adolescent Vaccination Program (AVP) guides pediatric clinics on how to implement evidence-based strategies to increase HPV vaccination rates. These strategies comprise the adoption of (1) immunization champions, (2) provider assessment and feedback, (3) continuing education, and (4) prompts, (5) parent reminders, and (6) parent education. The AVP systems-based intervention has demonstrated increased HPV vaccination rates in large urban pediatric clinic networks. The purpose of this study was to assess the feasibility of using an online decision support tool, the AVP Implementation Tool (AVP-IT), to implement AVP strategies in safety-net clinics to improve healthcare for the medically underserved in Texas. Methods: AVP immunization clinic staff champions in four urban safety-net clinics completed tailored Action Plans within the AVP-IT to guide strategy implementation, received webinar training from the research team commensurate to each AVP strategy, and participated in monthly monitoring calls with AVP-IT project staff over a 33-month period from 2022 to 2024. Results: All clinics made progress toward full implementation of AVP strategies. Interrupted time series (ITS) trend analysis demonstrated that AVP-IT implementation was associated with an immediate boost in HPV vaccine initiation rates (p < 0.001) and that long-term trends (ITS slopes) were significant for HPV, MCV4, and Tdap vaccines despite low post-COVID-19 pandemic rates (p < 0.001). Vaccination rates using raw data (mean differences) were not longitudinally significant except for older youth aged 13–17 years. Conclusions: The AVP-IT promises accessible and practical decision support to implement strategies to increase HPV vaccination rates in safety-net clinics. Scale-up in these clinics will require leadership support, technical assistance, and EHR optimization.