Wide Open Spaces: Supporting HPV Vaccination in Rural Communities

Partnering with Schools to Increase HPV Vaccine Coverage in Rural Communities along the U.S.-Mexico Border

We’re all feeling disheartened by the recently released NIS-Teen 2022 data. For the first time since the HPV vaccine entered the market, we didn’t see the “slow but sure” year-to-year rise in HPV vaccination coverage among U.S. teens. Instead, rates of HPV vaccination initiation (i.e., ≥1 dose) and up-to-date coverage nationally remained steady from 2021 to 2022. More worrisomely, coverage declined among uninsured and Medicaid-insured teens, signaling a potential exacerbation of socioeconomic disparities in HPV vaccination. At the same time, HPV vaccination rates remained significantly lower among teens living in rural areas compared to their city-dwelling counterparts.

These data are bleak, especially if they are considered alongside the mounting evidence that, for the first time in decades, the incidence of cervical cancer-- a disease entirely preventable through HPV vaccination, screening, and early detection and treatment— has reversed its steady course of decline, and is now also increasing, specifically among persons living in areas of poverty. Furthermore, in certain areas of the U.S., such as the Lower Rio Grande Valley of Texas along the U.S.-Mexico border, preventable cases of cervical cancer are diagnosed at a rate comparable to that of many low-income countries where HPV vaccination is not widely available. 

There is thus a critical and urgent need to ramp up, scale up, and expand the reach of our prevention efforts… and tap into innovative tools and strategies that will allow us to do so.

group of nurses posing around a table

A school-based HPV vaccination program in the Lower Rio Grande Valley is doing just that. As a medically underserved area, where approximately 1 in 3 residents are uninsured, there is a cap on what can be achieved in the region through clinic-based vaccination. Through a series of grants from the Cancer Prevention and Research Institute of Texas (CPRIT), a diligent team of researchers and public health practitioners is working to make HPV vaccination, and other routinely recommended and catch-up adolescent vaccinations, widely available at middle schools throughout the region. The team works with school district leadership and nurses to plan on-campus, school vaccination events that students can attend during (and before and after) school hours to get the vaccines they need at no cost to their parents or caregivers. The events are paired with an intense awareness and education campaign around HPV vaccination targeting parents and caregivers, school faculty and staff, and local healthcare providers. The results are astonishing. In one school district (the first to participate in the program), HPV vaccination initiation rates among middle-school students increased from 39.7% at baseline to 68.5% in Year 3 of the three-year program. Further, up-to-date rates increased from 17.9% to 42.1% over the same period. Other school districts are experiencing similar results as the program continues to grow and expand its reach into more rural and remote counties along the U.S.-Mexico border.

The program attributes its success to its ability to address the significant barriers to HPV vaccination experienced by rural families in the region:

  • Inadequate healthcare coverage. HPV vaccinations were provided at no cost to the families.
  • There are few local healthcare providers and long distances to healthcare services in neighboring towns. HPV vaccination education and administration were offered at schools – where children are.
  • Time constraints for busy parents and caregivers (many of whom work multiple jobs). HPV vaccination in school settings makes it easy for families.
  • Low awareness and knowledge of the HPV vaccine. HPV vaccination education was paired with vaccination availability. 

Challenges of low rural HPV vaccination coverage are met by meeting parents and caregivers where they are: at the drop-off and pick-up lines at their children’s school!    

We invite guest contributors to share information on how they are working to improve HPV vaccination in rural areas. If you want to contribute or learn more about our efforts to improve HPV vaccination in rural communities, please email us.

image of Jane Montealegre

Jane Montealegre, PhD

Associate Professor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center