Potential process improvements to increase coverage of human papillomavirus vaccine in schools - A focus on schools with low vaccine uptake.

Introduction: Human papillomavirus (HPV) vaccination is offered in Australia through school-based programs. While HPV vaccination coverage is high, coverage of the full course of vaccination is suboptimal in Australia and there is a drop in coverage between the first and third doses. This study aimed to describe the drivers of low HPV vaccination coverage in Western Australian (WA) schools and barriers and enablers to improving vaccine coverage. This paper focusses on process and system-level factors.

Materials And Methods: This was a mixed methods study. We analysed WA vaccination coverage data by school, undertook an online survey targeting the individuals responsible for the HPV vaccination program in their schools and school nurses, and compared survey findings and HPV vaccine dose three coverage in schools with 50 or more students in the eligible cohort. We also conducted focus groups with students and interviews with parents in schools with low HPV vaccine coverage.

Results: Schools with low HPV vaccine coverage had low coverage for the first dose of HPV vaccine as well as a higher drop off between first and third doses compared to schools with higher HPV vaccine coverage. Respondents from low and middle HPV vaccine coverage schools reported more issues with return of consent forms, low parental literacy, language barriers, absenteeism and difficulty contacting parents compared to schools with high coverage. Parents and students raised a number of challenges in relation to HPV vaccination including student absenteeism, language barriers, and issues with the return of consent forms.

Conclusions: A multifaceted approach to improving HPV vaccination coverage should be targeted at schools with low coverage. Based on our findings, these actions should include a range of approaches to obtaining parental consent and intensive follow up with students who are absent on vaccination days.