Addressing HPV vaccination in Southwest GA

The Emory Cancer Prevention and Control Research Network

September 2025

By Cam Escoffery, PhD

The Emory Rollins School of Public Health Cancer Prevention and Control Research Network (CPCRN) was funded in fall 2019 and had multiple projects related to HPV vaccination for the five-year project period. Cam Escoffery, PhD is the lead researcher from the Rollins School of Public Health and other investigators include Michelle Kegler, DrPH, Robert Bednarcyzk, PhD, Sarah Blake, PhD, Yue Guan, PhD, and Alex Morshed, PhD. The CPCRN is a national network of academic, public health, and community partners who work together to reduce the burden of cancer, especially among those disproportionately affected. The Emory CPCRN is one of the eight funded universities that has focused their work on HPV vaccination. 

At the time of funding, HPV vaccination rates were suboptimal in Georgia than they were nationally with first  and third dose coverage at 54% and 38% among girls and 51% and 28% among boys, respectively. Only 46% overall were up-to-date with their vaccinations. In addition, the percentage of adolescents who received the first dose of the vaccination was 11% lower in rural areas compared to urban areas in 2017 in the U.S. Therefore, we wanted to study methods to increase HPV vaccination in rural areas of Georgia. 

We funded four county health departments in rural, Southwest Georgia for the HPV Vaccine Mini-Grant Program to implement a multi-level intervention to increase HPV vaccination in Southwest Georgia. We conducted this program from January to December 2023. Through the mini-grant program, we provided health departments with up to $10,000, a toolkit with evidence-based strategies to increase HPV vaccination rates, and monthly collaborative or technical assistance calls. The sites were required to choose two out of the three levels (patient, provider, and practice) and implement strategies for each level for a year. Common strategies were patient education, patient incentives for vaccination, provider training, extended clinic hours, and patient reminders for subsequent HPV vaccination doses. The health departments reported on their activities with progress reports.  

From November 2023 to March 2024, Escoffery and the Emory CPCRN team conducted an implementation evaluation. Patients, including young adults and parents of vaccinated children, completed a survey about their experience receiving the HPV vaccination at the funded health department sites. Health department staff also completed a survey asking about the patient reach and the effectiveness of the levels, implementation facilitators and barriers, ratings about acceptability and feasibility of delivery of the intervention, and strategies each site chose to implement. In addition to the staff survey, interviews were conducted to explore the facilitators and barriers of implementing the multi-level intervention at their site.  

Highlights of the mini-grant results included: 

• Total HPV vaccinations increased 27% from 2022 to 2023 and the first quarter 2024 across the health departments with rates varying across departments.  For HPV vaccination initiation, the number of shots went from 191 to 290 with a 52% increase overall over the same time period of 2023 to the first quarter 2024. 
• Of the 20 parents who completed a survey, all reported that they saw educational materials (100%) 
• Parents also reported receiving educational materials (90%) and a vaccination reminder (75%) 
• Overall, health department staff reported positive experiences with program implementation and perceived the program was feasible (M=4.2), acceptable (M=4.5), and appropriate (M=4.2) 

Key facilitators of program delivery included the topic’s relative priority, leadership involvement, technological infrastructure, communication about the HPV vaccination and program, availability of resources (e.g., funding, materials), staff training, and support from other agencies. 

Barriers included limited resources, communication, and structural characteristics (e.g. technology/electronic health record) and local attitudes and conditions. We provided the health department sites with site-specific evaluation reports with the results from the patient and staff surveys, and staff interviews. These findings demonstrated this multi-level HPV mini-grant program increased HPV vaccination rates in rural Southwest Georgia. 

About the author

Cam Escoffery, PhD, is a Professor at Rollins School of Public Health of Emory University. She has conducted research for over 29 years on health promotion, cancer prevention and control, health technology, evaluation and implementation science.  Her current research aims to translate evidence-based interventions related to cancer control and self-management into practice. She has conducted research on HPV vaccination among immigrants and rural populations and designed interventions to promote vaccine uptake. She has served as PI on grants funded by the National Cancer Institute, Centers for Disease Control and Prevention, American Cancer Society and Health care Georgia Foundation.