Enhancing Human Papillomavirus Vaccination Uptake After Loop Electrosurgical Excision Procedure (LEEP) at Colposcopy: A Quality Improvement Study

OBJECTIVES: Emerging evidence demonstrates the benefit of adjuvant HPV vaccination at the time of loop electrosurgical excision procedure (LEEP) in reducing cervical intraepithelial neoplasia 2+ (CIN2+) recurrence. Our primary objective aimed to increase the HPV vaccination rate by 15% over 6 months among a high-risk patient population seen in colposcopy. A secondary objective surveyed patient barriers to vaccination. METHODS: This interrupted time series quality improvement study followed 127 immunocompetent patients aged 24-45 undergoing their first LEEP for high-grade cervical dysplasia from January to June 2023 in a quaternary colposcopy clinic. Interventions included nurse-led education and providing Gardasil-9 prescriptions to unvaccinated patients. The primary outcome was the total vaccination rate at 6 months. Weekly rates of prescription and patient brochure distribution, and the proportion of newly vaccinated patients by follow-up, were tracked as process measures to inform Plan-Do-Study-Act cycles. Balancing measures included cost and vaccine reactions. Data was analyzed with descriptive statistics, Mann-Whitney tests, and statistical process control (p) charts. RESULTS: Among eligible patients, 73/127 (56.6%) were unvaccinated at the time of LEEP. Among patients seen in follow-up, 47.9% (n = 34/71) started the vaccine series. The proportion of patients who pursued vaccination by their 6-month follow-up appointment increased from 42.5% (n = 54/127) to 69.3% (n = 88/127), a 26.8% absolute increase. Among the still unvaccinated cohort seen in follow-up (n = 37/71; 52.1%), the most common barriers were cost (n = 12/37; 32.4%) and time restraints (n = 9/37; 23.3%). CONCLUSIONS: Collaborative interventions to identify and counsel unvaccinated patients undergoing their first LEEP increases HPV vaccination rates, presenting an effective opportunity to engage patients in cervical cancer prevention.