{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:52:59Z","timestamp":1792090379489,"version":"4.4.0"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The human papillomavirus (HPV) vaccine is safe and effective, yet vaccination coverage remains below public health objectives in many countries.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the effectiveness of a 3-component intervention on HPV vaccination coverage among adolescents aged 11 to 14 years 2 months after the intervention ended, each component being applied alone or in combination.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>A cluster randomized trial with incomplete factorial design (PrevHPV) was conducted between July 1, 2021, and April 30, 2022, in French municipalities receiving 0, 1, 2, or 3 components of the intervention. Randomization was stratified by school district and municipalities\u2019 socioeconomic level. Analyses were carried out on 11- to 14-year-old adolescents living in all participating municipalities, regardless of what had been implemented.<\/jats:p><\/jats:sec>Intervention<\/jats:title>The PrevHPV intervention had 3 components: (1) educating and motivating 11- to 14-year-old adolescents in middle schools, along with their parents; (2) training general practitioners (GPs) on up-to-date HPV information and motivational interviewing techniques; and (3) free HPV vaccination at school.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was HPV vaccination coverage (\u22651 dose) 2 months after the intervention ended among 11- to 14-year-old adolescents living in participating municipalities, based on the French national reimbursement database and data collected during the trial in groups randomized to implement at-school vaccination.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 91 municipalities comprising 30\u202f739 adolescents aged 11 to 14 years (15\u202f876 boys and 14\u202f863 girls) were included and analyzed. Half the municipalities were in the 2 lowest socioeconomic quintiles and access to GPs was poor in more than two-thirds of the municipalities. Thirty-eight of 61 schools (62.3%) implemented actions and 26 of 45 municipalities (57.8%) had at least 1 trained GP. The median vaccination coverage increased by 4.0 percentage points (IQR, 2.0-7.3 percentage points) to 14.2 percentage points (IQR, 9.1-17.3 percentage points) at 2 months. At-school vaccination significantly increased vaccination coverage (5.50 percentage points [95% CI, 3.13-7.88 percentage points]) while no effect was observed for adolescents\u2019 education and motivation (\u22120.08 percentage points [95% CI, \u22122.54 to 2.39 percentage points]) and GPs\u2019 training (\u22121.46 percentage points [95% CI, \u22123.44 to 0.53 percentage points]). Subgroup analyses found a significant interaction between at-school vaccination and access to GPs, with a higher effect when access was poor (8.62 percentage points [95% CI, 5.37-11.86 percentage points] vs 2.13 percentage points [95% CI, \u22121.25 to 5.50 percentage points]; P<\/jats:italic>\u2009=\u2009.007 for interaction).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cluster randomized trial, within the context of the late COVID-19 pandemic period and limited school and GP participation, at-school HPV vaccination significantly increased vaccination coverage. The trial did not show a significant effect for training GPs and education and motivation, although it may be observed after more time has elapsed after the intervention.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT04945655<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.11938","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T15:33:33Z","timestamp":1716478413000},"page":"e2411938","source":"Crossref","is-referenced-by-count":29,"title":["Effectiveness of a School- and Primary Care\u2013Based HPV Vaccination Intervention"],"prefix":"10.1001","volume":"7","author":[{"given":"Nathalie","family":"Thilly","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Lorraine, APEMAC, Nancy, France"},{"name":"D\u00e9partement M\u00e9thodologie, Promotion, Investigation, Universit\u00e9 de Lorraine, CHRU-Nancy, Nancy, 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