Is abortion care an opportunity for healthcare maintenance? Promotion of HPV vaccination at time of abortion visit
Awarded 2017
Complex Family Planning Fellowship Research
Sharon Gerber, MD
Planned Parenthood of New York City

The Human Papilloma Virus (HPV) is a ubiquitous virus composed of over 40 sexually transmitted virus strains. With the available of the HPV vaccine in 2006, the opportunity to prevent these cancers was introduced. The vaccine is recommended by the CDC for all females aged 9-26. According to the CDC, rates of vaccination are relatively low for the HPV vaccine and continue to fall behind routine vaccines such as Tetanus, Diptheria and Pertussis (Tdap) and the Meningococcal vaccine (MenACWY). The United States Department of Health and Human Services Healthy People 2020 goal is to vaccinate 80% of young girls to vaccine series completion. As of 2016, researchers estimate that only 6 in 10 girls ages 13-17 have received at least one HPV vaccination with only 49.5% completing the series. This leaves a large unmet gap for healthcare providers of 18 to 26-year-olds to identify the need for vaccination and to offer HPV vaccine series catch-up.
The primary objective of this study is to explore whether the abortion visit is an opportunity to engage young adults aged 18-26 who are still eligible to receive the HPV vaccine and assess their attitude towards the abortion visit as an opportunity to receive preventative health care services. The secondary objective of this study is to measure HPV vaccine prevalence in our population of eligible adult women aged 18-26.
We conducted a prospective cohort study in which we offered the HPV vaccine to eligible patients presenting for abortion services at an outpatient abortion center. We administered surveys to all participants at the initial study visit, to assess utilization of health services, knowledge of the HPV vaccine, and reasons for not having initiated or completed the vaccine series previously. We performed a retrospective electronic medical record review to determine HPV vaccine prevalence in our patient population of women aged 18-26.
101 study participants were offered HPV vaccination; 50 participants accepted and 51 participants declined. Vaccine acceptance was significantly associated with not being previously aware that HPV causes cervical cancer. The most common reason among both groups for not initiating the vaccine was that it had not previously been offered. Prior to the study visit 34.0% of Acceptors and 33.0% Decliners were planning to start or to complete the vaccine series. Among all participants, 44.0% of Acceptors and 35.3% of Decliners had not previously heard of the HPV vaccine. The majority of study participants from both groups described the abortion visit as a good opportunity to receive other healthcare services (87.1%).
From January 1, 2016 to December 31, 2016 there were a total of 30,092 independent charts for women 18-26 years of age presenting for abortion or for Sexual and Reproductive Health services (SRH). 61.7% of all patients were eligible for one or more HPV vaccinations. In an analysis of patients presenting for abortion only, 62.3% were eligible for one or more vaccinations.
The abortion visit may be an opportunity to start or finish the HPV vaccine series. The majority of patients presenting for abortion are receptive to receiving additional services. More than half of these patients were never previously offered the HPV vaccine. Practices and policies that are aimed at utilizing missed opportunities for HPV vaccine catch up can increase HPV vaccine prevalence among young adult women.