以学校和初级保健为基础的多组分干预提高HPV疫苗覆盖率的实施评估：来自PrevHPV随机对照试验的结果

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-08-15 DOI:10.1016/j.jiph.2025.102931

Aurélie Bocquier , Maïa Simon , Morgane Michel , Stéphanie Bonnay , Isabelle Adam , Serge Gilberg , Sébastien Bruel , Aurélie Gauchet , Anne-Sophie LeDuc-Banaszuk , Amandine Gagneux-Brunon , Judith E. Mueller , Bruno Giraudeau , Nathalie Thilly , on behalf of the PrevHPV Study Group

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引用次数: 0

摘要

背景：法国人乳头瘤病毒（HPV）疫苗覆盖率（VC）仍低于预期。PrevHPV国家研究规划旨在共同制定和评估一项干预措施，其中包括三个组成部分：学校青少年的“教育和动机”、“学校疫苗接种”、“全科医生（gp）培训”。本研究旨在评估每个组成部分的实施结果，它们是否影响有效性，并确定影响学校实施的因素。方法在法国91个城市（2021年7月- 2022年6月）采用混合方法进行整群随机对照试验。定量数据通过活动报告和问卷收集，定性数据通过与学校工作人员的焦点小组收集。按照医学研究委员会复杂干预措施过程评价指南和Proctor等人的《实施结果框架》的定义，实施结果为保真度、剂量、覆盖范围、可接受性和可持续性；干预结束后2个月的有效性指标为HPV VC（≥1剂量）。使用实施研究统一框架对定性数据进行分析。结果在完成干预的参与者中，这三个组成部分的保真度、可接受性和可持续性都很高。然而，在试验开始之前，三分之一的学校退出，以及动员全科医生的困难对剂量和覆盖率结果产生了负面影响。在治疗过程中对治疗效果分析的估计值大于未考虑干预剂量的估计值；“学校疫苗接种”（11.25个百分点，p <； 0.001）和“全科医生培训”（3.56个百分点，p = 0.049）增加了VC，而“教育和动机”仍然不显著。结论通过学校和初级保健机构的联合干预，可以提高青少年中HPV VC的感染率。本研究为在现实生活中实施此类干预提供了实际意义。临床试验注册：clinicaltrials .gov, NCT 04945655。注册日期：2021年6月30日，https://clinicaltrials.gov/study/NCT04945655

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Implementation evaluation of a school- and primary care-based multicomponent intervention to improve HPV vaccine coverage: Results from the PrevHPV randomized controlled trial

Background

Human papillomavirus (HPV) vaccine coverage (VC) remains lower than expected in France. The PrevHPV national research program aimed to codevelop and evaluate an intervention including three components: ‘education and motivation’ of adolescents in schools, ‘at-school vaccination’, ‘general practitioners (GPs)’ training’. This study aimed to evaluate the implementation outcomes of each component, whether they affected effectiveness, and identify factors influencing implementation in schools.

Methods

A mixed-method study embedded in a cluster randomized controlled trial in 91 French municipalities (July 2021-June 2022). Quantitative data were collected through activity reports and questionnaires, and qualitative data through focus groups with school staff. The implementation outcomes were fidelity, dose, reach, acceptability and sustainability, as defined in the Medical Research Council guidance for process evaluation of complex interventions and Proctor et al.’s Implementation Outcomes Framework; the effectiveness outcome was HPV VC (≥ 1 dose) two months after the end of the intervention. Qualitative data were analyzed using the Consolidated Framework for Implementation Research.

Results

The fidelity, acceptability, and sustainability of all three components among participants who completed the intervention were high. However, the withdrawal of one-third of schools before the trial started and difficulties in mobilizing GPs negatively impacted the dose and reach outcomes. Estimates for the on-treatment analyses of the effectiveness were greater than those for which the dose of intervention received was not considered; ‘at-school vaccination’ (11.25 percentage points, p < 0.001) and ‘GPs’ training’ (3.56 percentage points, p = 0.049) increased VC, while ‘education and motivation’ remained nonsignificant.

Conclusions

Increasing HPV VC among adolescents could be achieved by combining interventions in both schools and primary care settings. This study provides practical implications for implementing such interventions in real life.

Trial registration

Clinicaltrials.gov, NCT 04945655. Registered 30 June 2021, https://clinicaltrials.gov/study/NCT04945655

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.