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Logo of the project Intervention Study to Increase HPV--Human papillomavirus Vaccination Coverage in Germany

Intervention Study to Increase HPV Vaccination Coverage in Germany

Project team: Dr. Anja Takla (Project manager), Nora Schmid-Küpke (Deputy project manager), Yvonne Bichel, Johannes Lachmann, Selina Teindl, Julia Wilhelm, Elisa Wulkotte

Contact information:

Collaborating partners:

Supported by:

Project period: 2023/01/01 – 2026/06/30

Funded by: The Federal Ministry of Health (BMG)

Logo: Supported by: Federal Ministry of Health

Why is it necessary to carry out a project to increase HPV vaccination coverage in Germany?

Infections with high risk types of the Humane Papillomavirus (HPV) are causing cervical cancer and are associated with penis, anus and mouth/throat cancer. Currently, almost 8,000 new cases of cancer per year can be attributed to HPV in Germany. There are highly effective and safe vaccines available to prevent HPV associated cancer. The German Standing Committee on Vaccination (STIKO) recommends all girls (since 2007) and boys (since 2018) between the age of 9-14 years to be vaccinated against HPV. The WHO and the European Commission aim to achieve a vaccination coverage of at least 90% among 15-year-old girls and a significant increase in the vaccination coverage among 15-year-old boys by 2030. However, in Germany only 54% of 15-year-old girls and 27% of 15-year-olds boys were fully vaccinated against HPV in 2021. As a result, nearly half of all the girls and two-third of the boys in Germany are growing up to be young adults without protection against HPV related cancer.

The project at a glance

The aim of InveSt HPV is to investigate and evaluate different approaches to increase the HPV vaccination coverage in Germany. For the realization of the project, RKI is supported by various cooperation partners and institutions. The results of the study potentially inform nationwide measures to increase HPV vaccination coverage in Germany.

Module 1 focuses on the sparse usage of recall systems in Germany. As vaccines are administered almost exclusively at physicians' offices in Germany, physician contact is critical for vaccine uptake. Several studies have demonstrated the effectiveness of recall/reminder systems for keeping vaccination appointments. Therefore, module 1 investigates barriers to the use and dissemination of recall systems for childhood HPV vaccinations in Germany. Pediatricians and parents with children aged 9 to 14 years are surveyed regarding their use and acceptance of recall systems, especially for HPV vaccinations. In addition, statutory health insurance companies are questioned concerning their use of childhood HPV vaccination recall systems. A systematic literature review is planned to provide an overview about existing evidence on the effectiveness of recall systems for childhood HPV vaccination and to complement the results of the surveys. Based on survey results, solution strategies and action recommendations to increase the usage and acceptance of recall systems for HPV vaccination are developed. The survey results are further complemented by informal background interviews with specialists and stakeholders. Those solution strategies and recommended actions will finally be discussed in a workshop with all relevant stakeholders in Germany. Further aim of the workshop is to facilitate the development of ideas for implementation and to derive next steps for potential pilot projects.

InveSt HPV - Modul 1 Recall systems. Source: RKI InveSt HPV - Modul 1 Recall systems.

There is broad evidence pointing to the importance of the communication between physicians and patients regarding the vaccination decision. The communication concerning childhood HPV vaccination is considered particularly challenging as parents often do not have much knowledge about HPV or experience shame as HPV is a sexually transmitted infection. Therefore, module 2 concentrates on the communication between health workers and patients to increase childhood HPV vaccine uptake. In this context Motivational Interviewing is explored as an innovative communication approach in Germany to train pediatricians and medical nurses. Participating pediatric practices in the two intervention regions are randomly assigned to one of three intervention arms and thus receive either (i) classical training aiming to improve knowledge about HPV, (ii) training in Motivational Interviewing, or (iii) no training (control group). To inform the content of the training, a needs assessment and knowledge assessment regarding HPV is conducted among parents, pediatricians and medical nurses (representative nationwide survey). To evaluate the effect of the intervention, vaccine uptake rates per randomization arm are compared between pre and post intervention period. Additionally, all trainings in itself (e.g. effect on increase of knowledge on HPV) are evaluated.

InveSt HPV - Modul 2 Training. Source: RKI InveSt HPV - Modul 2 Training.

Date: 18.12.2023