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An at-school vaccination program in France significantly increased human papillomavirus (HPV) vaccine coverage, according to results of the PrevHPV cluster randomized trial.

Among girls and boys ages 11 to 14 years, a school-based program offering HPV vaccinations significantly increased median HPV vaccination coverage by an adjusted 5.5 percentage points after 2 months of the intervention, Morgane Michel, PhD, of the Universite Paris Cite, and colleagues reported in .

The intervention consisted of three components: free at-school HPV vaccination, education and motivation of adolescents and their parents, and a training program for general practitioners (GPs). "Free HPV vaccination on school premises was the only component that consistently and significantly increased vaccination coverage," Michel and colleagues wrote.

The increase in HPV vaccine coverage was highest in the intervention group that used at-school vaccination combined with adolescent education and motivation, increasing from a baseline of 14.8% to 30%. The combination of at-school vaccination in conjunction with adolescents' education and GP training was associated with an increase from a baseline of 11.7% to 23.8% after the intervention.

In the control group, the median vaccine uptake increased from 13.8% to 17.8%.

Would offering at-school HPV vaccines work here in the U.S.? "It's hard to generalize about a study from a different country," Michael Smith, MD, of Duke University School of Medicine in Durham, North Carolina, told MedPage Today.

"Certainly, in general, bringing vaccines to schools is going to help with vaccine inequities," Smith said. "But it's unclear to me how much of HPV undervaccination is due to lack of access versus social and cultural beliefs."

Michel's group reported that at baseline, median vaccine coverage in the PrevHPV trial was 13.6% among the adolescents in France.

After at the end of the trial, the French government started offering both doses of the HPV vaccine free of charge to all grade 7 students. Only "approximately 10% of pupils have received the first dose, with much concern raised around unfounded vaccine safety concerns," the authors noted from preliminary reports.

Of note, when Michel and colleagues performed a subgroup analysis, they found that vaccine uptake increased more in the at-school vaccination groups that had poor access to GPs than in those groups that had better access (8.62 vs. 2.13 percentage points, P=0.007 for interaction).

Also, researchers found that vaccine coverage improved the most in municipalities with the lowest socioeconomic levels with at-school vaccination. In a regression model, at-school vaccination increased vaccine uptake by a similar magnitude for both boys and girls.

Smith pointed out that HPV vaccine coverage tends to be higher in the U.S.

According to a 2022 CDC report, the proportion of 13- to 17-year-olds -- a somewhat older age group than adolescents enrolled in the PrevHPV trial -- who received at least one dose of HPV vaccine in 2022 was 76%, and about 62% were considered up-to-date on HPV vaccination. Michel and colleagues noted that full HPV vaccine coverage in France in 2022 was 41.5% for girls who were 16 years of age and 8.5% among boys of the same age.

The starting the two-dose HPV vaccine series no later than age 15 and ideally by ages 11 or 12.

The PrevHPV trial, conducted between the beginning of July 2021 and the end of April 2022, included 91 municipalities in France comprising 30,793 adolescents ages 11 to 14. Among the adolescents, 15,876 were boys and 14,863 were girls. Municipalities were randomized into six intervention groups that received varying combinations of intervention components.

Access to GPs was poor in more than two-thirds of the municipalities. About half of the municipalities were in the two lowest socioeconomic quintiles in France. Most of the schools were public.

The study had a drop-out rate ranging from 25% to 53% of schools assigned at least one school-based intervention. However, about 62% of schools implemented at least part of a component. About 58% of municipalities randomized to GP training had at least one GP who underwent the training.

Michel and colleagues noted that the study took place during the part of the pandemic when schools had to deal with contact tracing and COVID-19 vaccination, which may have led to the high dropout rate or being unable to fully implement the interventions. This time period may have also made it difficult for GPs to fully participate.

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