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Collaboration between Local Health Departments and Jails for HPV Vaccine in Region VII

Collaboration between Local Health Departments and Jails for HPV Vaccine in Region VII. Molly Allison, MPH Megha Ramaswamy, PhD, MPH University of Kansas Medical Center Department of Preventive Medicine and Public Health.

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Collaboration between Local Health Departments and Jails for HPV Vaccine in Region VII

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  1. Collaboration between Local Health Departments and Jails for HPV Vaccine in Region VII Molly Allison, MPH Megha Ramaswamy, PhD, MPH University of Kansas Medical Center Department of Preventive Medicine and Public Health

  2. Overview- Part I. HPV vaccine knowledge and intention among inmates- Part II. Health department readiness to collaborate with jails for HPV vaccine- Part III. HPV vaccine implementation in Wyandotte County

  3. Part I. HPV Knowledge and Intention – Adult Inmates in Kansas • October 2016 & January 2017: Collected surveys from 571 adult inmates in 3 Kansas jails (Wyandotte, Olathe, & Gardner) • Surveys measured HPV knowledge & vaccine awareness, intention and uptake

  4. Part I. HPV Knowledge and Intention – Results • Response rates: • Wyandotte - 61% (165/270) • Olathe – 75% (106/141) • Gardner – 61% (300/485) Allison et al., Am J Public Health, 2018

  5. Part I. HPV Knowledge and Intention – Results

  6. Part I. HPV Knowledge and Intention – Results

  7. Part I. HPV Knowledge and Intention – Results

  8. Part I. HPV Knowledge and Intention among Juveniles • N=46 juveniles aged 10-18 interviewed • 15/46 (33%) reported receiving vaccine (69%, N=32 had received HPV vaccine per health department records) • Most receptive about getting vaccine in jail, though have concerns about who would give shot • In practice… challenges to delivering HPV vaccine • One other study shows that most state facilities offer HPV vaccine (wards of the state), but not most county detention facilities Allison et al., Prev Med Reports, in prep

  9. Part II. Health Department Readiness to Collaborate with Jails for HPV Vaccine • September 2017 – April 2018: all LHDs in Region VII (KS, MO, IA, NE) invited to take survey about readiness to work with local jails for HPV vaccine • 68% Response rate (237/344) Ramaswamy et al., Implement Sci, under review

  10. Survey Development • 32-item survey based on CFIR model • Focus group with 6 health department/7 jail administrators and staff • Prompts developed according to CFIR • Data open-coded • Investigators organized codes/quotes/field notes by CFIR constructs; added evidence from literature to develop survey questions • Implementation science consultant reviewed • Survey questions piloted with one local health department

  11. Part II. Health Department Readiness Table 1. LHD Characteristics, Kansas, Missouri, Iowa and Nebraska, N =237

  12. Part II. Health Department Readiness Table 2. LHD Healthcare Provider Availability (≥0 days/month), N (%) NP/PA = nurse practitioner/physician assistant ǂ For state-level comparisons, p<0.01 (chi-square test). For registered nurse comparisons, p=0.02

  13. Part II. Health Department Readiness

  14. Part II. Health Department Readiness

  15. Part II. Health Department Readiness Top 3 challenges in providing vaccinations to inmates: Cost – 66% Short length of stay for inmates – 47% Medical staffing available – 43% Security concerns: -Inmate issues – 40% -Approval for jail access – 11% -Following security requirements at jail – 9%

  16. Part II. Health Department ReadinessHPV Education – Top 3 methods: 1. Health education from health department – 37% 2. Pamphlets or posters – 27% 3. Training for jail medical/correctional staff – 9%

  17. Part II. Health Department Readiness

  18. Part II. Health Department ReadinessFactors significantly associated with readiness to implement: • Number of full-time employees (OR 2.22, 95% CI 1.24, 3.95) • Important for jails to offer HPV vaccine • (OR 3.70, 95% CI 2.00, 6.84) • Already provide any vaccines in local jails • (OR 2.62, 95% CI 1.18, 5.80) INNER SETTING CFIR VARIABLES

  19. Part III. Implementation at WYCOMay 2017 – June 2018 • Facilitators of HPV education and vaccinations on juvenile side • Barriers to implementation on adult side • Next steps Kelly et al., Health PromotPract, in prep

  20. Part III. Implementation at WYCO Facilitators of HPV education & vaccinations for kids: Health Educator and/or Molly arrived for HPV education at least once per month Told kids about vaccine program, asked if they’d like Molly to contact parents/guardians to notify them about program Parents/guardians filled out consent form in visitation room Nurses contacted to arrange visit 2 kids completed vaccination series!

  21. Part III. Implementation at WYCO 2 kids completed HPV vaccination series from May 2017-June 2018 (13 months):10 HPV education sessions over 13 months with Health Educator and/or study team memberStudy team member also provided education & announced vaccine program to larger group when visiting kids for surveys (February 2017- February 2018, on average once per month)

  22. Part III. Implementation at WYCO • Barriers to implementation on adult side • Staff shortage/availability • Funding for vaccine • Background checks – Already submitted for health department, but no way to get around re-submitting for jail

  23. Part III. Implementation at WYCO • Next steps? • HPV education for kids • Continuing vaccinations on juvenile side • Point of contacts • Other steps?

  24. Conclusions • Majority of HDs find it important for jails to provide HPV vaccine to inmates, and 43% of HDs are interested in learning more about implementation • WYCO and many other health departments have barriers in cost and staffing when thinking about implementation of jail-based vaccine clinic • Success of vaccinating 2 kids – finished vaccine series and completely covered! Also success in finding out 69% of kids were already vaccinated • Dissemination ongoing (1 paper published; 3 under review)

  25. Next Steps • Complete surveys with all jails in Region VII 142/347 (41%) • Match “ready” health departments with jails to identify most likely implementers • Collect data from N~20 health departments, jails, state facilities that vaccinate for HPV about implementation strategies • Figure out what scale up looks like

  26. AcknowledgmentsR21 CA204767, “Correctional and public health links to bolster HPV vaccine and cancer prevention” National Cancer Institute: Sarah Kobrin, David Chambers, Cynthia VinsonWyandotte County, Kansas:Detention Center Warden Jeffrey Fewell and Wyandotte County Health Department Administrator Terrie GarrisonSexual Health Empowerment team www.kumc.edu/she: Brynne Musser, Joi Wickliffe, Katherine Gwynn, Robert Armstrong, Pat Kelly

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