Human Papillomavirus (HPV) is the most common sexually transmitted infection currently affecting
nearly 80 million people in the United States. Southern states have disproportionately high incidence rates of
HPV-related cancers; Arkansas has the highest incidence rate (14.4 per 100,000) in the US. Vaccines exist to
protect against the cancer-causing strains of HPV and are recommended for all children beginning at age 11,
but vaccination rates remain low. Vaccines For Children (VFC) is a program administered by the Centers for
Disease Control and Prevention (CDC) that provides free vaccines to providers for administration to children at
no charge. All children under age 18 and enrolled in Medicaid or uninsured are eligible. Despite the strong
reach potential afforded by access to free vaccines, participation in the South is low; only 4% of Arkansas
physicians are VFC providers and local health departments are the sole resource of VFC vaccines for 20 of 75
Arkansas counties. To improve the reach potential of the VFC program (and thereby HPV vaccination) in the
Southern US, this application will explore the use of community pharmacies as HPV vaccination sites.
Community pharmacies are highly accessible when compared to “traditional” vaccination sites due to
their extended hours in evening and on weekends, no copays for visits, and no requirement to schedule an
appointment to speak with a pharmacist. Pharmacists can administer vaccines to children aged 7 and older as
long as certain requirements are met, all of which include physician oversight. This application proposes a
variety of potential “collaboration models” which can be utilized by pharmacists and physicians interested in
providing more HPV vaccines. One example is a “shared responsibility model” in which the first dose of the
vaccine is administered in the physician's office while the second dose is administered in the pharmacy. This
study will use implementation science to determine and pilot-test a promising vaccine-delivery partnership
model between pharmacists and physicians and an array of supportive implementation strategies to support
uptake and sustainability of HPV vaccine provision in the community pharmacy setting. The following specific
aims are proposed: Aim 1) Identify barriers and facilitators to community pharmacies' provision of HPV vaccine
through a mixed methods design with pharmacy staff members and local physicians; Aim 2) Select a
pharmacist-physician collaborative model and identify implementation strategies through an Evidence Based
Quality Improvement (EBQI) process with key stakeholders; and Aim 3) Pilot the selected pharmacist-
physician collaborative model and implementation strategies in two pharmacies (1 rural, 1 urban) and evaluate
on relevant implementation outcomes. The long term goal of this project is to improve HPV vaccination rates
among adolescents in the US, especially in rural and underserved areas. Results from this study will provide
the foundation for a large cluster-randomized implementation trial that will include multiple community
pharmacy contexts – large and small, urban and rural, and chain- and independently-operated.
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