Effectiveness of a School- and Primary Care–Based HPV Vaccination Intervention
Nathalie Thilly, Morgane Michel, Maïa Simon, Aurélie Bocquier, Amandine Gagneux‐Brunon, Aurélie Gauchet, Serge Gilberg, Anne-Sophie Le Duc-Banaszuk, Sébastien Bruel, Judith E. Mueller, Bruno Giraudeau, Karine Chevreul, PrevHPV Study Group, Nelly Agrinier, Isabelle Adam, Stéphanie Bonnay, Estelle Fall, C. Pulcini, Marie Ecollan, Dragos‐Paul Hagiu, Josselin Le Bel, Henri Partouche, Juliette Pinot, Louise Rossignol, Arthur Tron, Minghui Zuo, Gaëlle Vareilles, Julie Bros, Catherine Juneau, Marion Branchereau, Élisabeth Botelho-Nevers, Géraldine Jambon, Florian Jeanleboeuf, J. Kalecinski, Christine Lasset, Laetitia Marie Dit Asse, Jonathan Sicsic, Jocelyn Raude, Sandra Chyderiotis, Damien Oudin Doglioni, Josée M. Dussault, Anne‐Sophie Barret, Isabelle Bonmarin, D Lévy-Brühl, Clémence Castagnet, Mélanie Simony, Julien Ailloud, Olivier Épaulard, Emily Darlington, Mabrouk Nekaa
Abstract
Importance: The human papillomavirus (HPV) vaccine is safe and effective, yet vaccination coverage remains below public health objectives in many countries. Objective: To 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 Participants: A 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. Intervention: The 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 Measures: The 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. Results: A 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 Relevance: In 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 Registration: ClinicalTrials.gov Identifier: NCT04945655.