# Implementing an evidence-based, multilevel intervention to promote HPV vaccination among HIV positive adults

> **NIH NIH R01** · EMORY UNIVERSITY · 2023 · $391,250

## Abstract

PROJECT ABSTRACT
People living with HIV (PLWH) are 28 times more likely to be diagnosed with anal cancer than the general
population. The Human Papillomavirus (HPV) is associated with >90% of anal cancers, and is also a significant
cause of cervical, vaginal, penile, and oral cancers seen in this population. The HPV vaccine is an effective and
safe approach to prevent and reduce the risk of HPV-related disease among PLWH. However, HPV vaccination
remains low in PLWH despite formal recommendations from the CDC’s Advisory Committee on Immunization
Practices to vaccinate immunocompromised individuals up to age 26 years with the 3-dose series-- and recently
FDA approved to vaccinate up to age 45 years. The PI’s K01 serves as the rationale for this study. The PI found
significant delays in follow up care after an abnormal anal Pap test. Delays in follow up after an anal Pap test in
the absence of national guidelines to support screening in PLWH means the incidence of anal cancer will
continue to rise among PLWH, especially as this population ages. Therefore, promotion of the HPV vaccine in
this population as primary cancer prevention is a public health priority. However, the PI’s work found significant
gaps in knowledge and awareness of the HPV vaccine as well as low uptake of the HPV vaccine (13.5%) in our
population of rural PLWH. These findings support the next logical step to reduce cancer disparities as well as
further the PI’s career trajectory through promotion of HPV vaccination among PLWH as part of a successful
cancer prevention plan. However, HPV vaccine programs tailored and implemented in the HIV population is
lagging for this high-risk group. The CDC’s 4 PillarsTM Transformation Program is a multi-level, evidence-based
intervention that has been successfully utilized to increase HPV vaccination in the general population and is
primed to be tested in the high-risk HIV population, particularly PLWH in the rural South. Guided by the RE-AIM
framework, we will implement this project in three HIV clinics in Georgia and enroll n=365 PLWH who are age
18-45 years from those clinics. Aim 1) Tailor and refine the 4 PillarsTM program for implementation in rural and
urban HIV clinics in Georgia; Aim 2) Test the effectiveness of the 4 PillarsTM program as measured by an increase
in uptake rate in initiation of the HPV vaccine (primary endpoint) and vaccine completion (secondary endpoint)
compared to historical baseline vaccination rate (control) among PLWH; Aim 2.1) Identify mediators and
potential moderators of the intervention effects on HPV vaccination; Aim 3) Assess the sustainability of the
intervention in vaccine uptake post-intervention; Aim 3.1) Assess scalability of the program for wider
implementation via a future national RCT. As an Early-Stage Investigator, the PI (Wells) has assembled an
outstanding research team that brings complementary expertise to successfully execute the aims of this research
proposal. The proposed study is a novel a...

## Key facts

- **NIH application ID:** 10616784
- **Project number:** 5R01NR020154-03
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Jessica Wells
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $391,250
- **Award type:** 5
- **Project period:** 2021-07-29 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10616784

## Citation

> US National Institutes of Health, RePORTER application 10616784, Implementing an evidence-based, multilevel intervention to promote HPV vaccination among HIV positive adults (5R01NR020154-03). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10616784. Licensed CC0.

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