Closing the HPV Vaccination Gap One Visit at a Time

By Maureen B. Boardman, DNP, FNP-C, FAANP

As a family nurse practitioner, I believe HPV vaccination is one of the most underutilized methods of cancer prevention that we have as health care clinicians. I became interested in the HPV vaccine over 20 years ago when I first came to Dartmouth and had the pleasure of working with Diane Harper, MD, one of the site and study investigators in multicentered clinical trials of prophylactic HPV vaccines. Since then, my interest in HPV and the HPV vaccine has grown and I was a primary investigator on an NIH grant looking at Clinician & Patient Utilization of Expanded Age Range for the HPV Vaccine and Shared-Decision Making. My Doctor of Nursing Practice (DNP) quality improvement project also addressed effectively educating clinical staff around the HPV vaccination and shared decision-making in this expanded age range (aged 27 to 45).

Unfortunately, despite the established effectiveness and safety of the HPV vaccine, rates of completed HPV vaccine series remain low, and are even lower in rural communities compared to urban areas. In the U.S., only 59% of 13- to 15-year-olds have completed the HPV vaccine series with lower coverage among adolescents in rural areas. In comparison, vaccination rates for tetanus, diphtheria, and pertussis (Tdap) and meningitis (MenACWY), given at approximately the same age as the HPV vaccine, are closer to 90%. This notable gap underscores an urgent public health failure in leveraging an effective tool for cancer prevention.

The good news is that there is a clear, evidence-based way to begin closing this gap. The Announcement Approach has been shown to increase HPV vaccine initiation among adolescents by 5% by reinforcing one of the most powerful drivers of vaccination: a clear, confident, and routine provider recommendation. During back-to-school visits, this means presenting the HPV vaccine the same way as Tdap and meningitis vaccines, as a standard, expected part of care. While we as rural health care clinicians often do not have the ability to effectively change the multifaceted reasons that contribute to our rural patients experiencing lower vaccination rates compared to their urban counterparts, this simple three-step approach offers a practical, high-impact way to improve uptake.

Recognizing the value of this approach in real-world practice, I pursued the opportunity last year to be trained as a facilitator in the Announcement Approach through the St. Jude HPV Cancer Prevention Program. After completing the training, I shared these strategies with rural health care students at The Rural Health Student Summit, hosted by the New England Rural Health Association, which brought together more than 125 students from across medicine, nursing, physician assistant, and public health programs in New England. I have since incorporated the Announcement Approach into my own rural practice at Little Rivers Health Care, a federally qualified health center with three sites in rural northeastern Vermont, where back-to-school visits provide a key opportunity to normalize and prioritize HPV vaccination for every eligible patient.

Now that I have completed my DNP at the University of New Hampshire, I look forward to expanding access to Announcement Approach trainings across northern rural New England. I also recently had the privilege of serving as a featured rural clinician panelist in Part 1 of the Improving HPV Vaccination in Rural Communities: A Communication Series, organized by the St. Jude HPV Cancer Prevention Program, American Cancer Society (ACS) and ACS National HPV Vaccination Roundtable, where I shared practical insights on implementing the Announcement Approach. Paired with Part 2 on motivational interviewing, the series highlighted how strong, routine recommendations can be complemented by patient-centered conversations when families have questions about HPV vaccination, an approach that closely reflects the realities of care in rural settings.

As clinics fill with back-to-school visits, making HPV vaccination a routine recommendation can turn these visits into powerful moments of cancer prevention to strengthen the health of our rural communities.

Maureen Boardman has been a family nurse practitioner for 35 years. She recently completed a DNP degree at the University of New Hampshire. She has been employed for the last 21 years at Little Rivers Health Care, a rural federally qualified health center in northeastern Vermont where she is Director of Clinical Quality and Research. She also teaches at Dartmouth Geisel School of Medicine where she is a Clinical Assistant Professor of Community and Family Medicine and is the Clinical Research Director of the Northern New England Practice & Community Based Research Network (NNE PCBRN). At the NNE PCBRN she engages in a variety of research projects related to primary care and community-based research. She served on an Agency for Healthcare Research Technical Expert Panel on Primary Care. She was one of 20 nurses chosen from across the country to serve on the National Nurse Vaccine Confidence Project, a national cooperative agreement funded by the Centers for Disease Control and Prevention (CDC) to build vaccine confidence among nursing providers, non-clinical health center staff and patient communities. Maureen has been a Primary investigator or Co-PI on two NIH grants exploring vaccine issues including the expanded age range for the HPV vaccine and rural COVID-19 vaccine hesitancy in Northern New England. She is a Dartmouth, Geisel School of Medicine Master Educator and is a Fellow in the American Association of Nurse Practitioners.