# IMPACT Project 1 – The impact of standing orders support on HPV vaccine communication and uptake

> **NIH NIH P01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $290,239

## Abstract

ABSTRACT – Project 1
 An ongoing and pressing cancer prevention challenge in the US is low HPV vaccine coverage, due in part
to infrequent and low-quality provider recommendations. Our 1-hour Announcement Approach Training (AAT)
teaches providers to use presumptive announcements that presume the child will receive vaccines and to use
best practices for respectfully addressing parent concerns when they arise. The AAT increases HPV vaccine
initiation and is an NCI-designated Research-Tested Intervention Program. To increase the impact of the AAT,
we propose to leverage the whole primary care team, including registered nurses (RNs) and medical assistants
(MAs), by supporting the implementation of existing standing orders. Standing orders are widely available but
often underused. As part of the P01 Program Project, “Improving Provider Announcement Communication
Training (IMPACT),” Project 1 will focus on AAT enhanced with standing orders support to expand the whole
primary care team's involvement in HPV vaccine recommendations. We will do this work in healthcare systems
serving rural and nonrural areas. Aim 1 is to characterize the role of RNs and MAs and standing orders in
HPV vaccination. We will conduct formative interviews (n=20) and then a national primary care team survey
(n=2,500) with our P01's Data Core to better understand how to expand the role of RNs and MAs in
recommending HPV vaccine and to implement existing standing orders for HPV vaccine. Aim 2 is to evaluate
the impact of supporting the implementation of existing standing orders for the whole primary care
team on HPV vaccine communication and uptake in an RCT. The standing orders support will be a series
of activation meetings that use persuasion and skills building with system leaders, clinic leaders and clinic staff.
We will conduct a trial in 40 primary care clinics in Mississippi, Missouri, and Texas that have HPV vaccination
standing orders, serve patients from rural and nonrural areas, and are part of a healthcare system. Clinics will
be randomized to AAT or AAT enhanced with standing orders support. The primary trial outcome will be clinic-
verified HPV vaccine initiation among children ages 11-12. We hypothesize that AAT with standing orders
support increases HPV vaccine uptake by improving HPV vaccine communication. Aim 3 is to generate
guidance for healthcare systems to support implementation of HPV vaccine standing orders to leverage
the whole primary care team. We will gather and share intervention data (cost, impact, and implementation
data) with Project 4 to support cost-effectiveness analyses and development of their decision support tool. We
will examine intervention implementation determinants and outcomes with our P01's Intervention Core. Finally,
we will contribute modules to the AAT Intervention Package that provides guidance to healthcare systems for
improving HPV vaccination. Project 1 addresses the IMPACT Program Project theme by building capacity for
HPV vacc...

## Key facts

- **NIH application ID:** 10926958
- **Project number:** 5P01CA250989-04
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Noel Todd Brewer
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $290,239
- **Award type:** 5
- **Project period:** 2021-09-23 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10926958

## Citation

> US National Institutes of Health, RePORTER application 10926958, IMPACT Project 1 – The impact of standing orders support on HPV vaccine communication and uptake (5P01CA250989-04). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10926958. Licensed CC0.

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