Closing the HPV vaccination gap with a mobile app

Fontenot became interested in the HPV vaccine after it was approved by the Food and Drug Administration (FDA) in 2006. One of the most common sexually transmitted infections, HPV can cause cervical cancer and other gynecological malignancies in women. But HPV promotes cancers in males too—including anal, penile, and oropharyngeal (mouth and throat) malignancies. (According to some projections, the annual number of oropharyngeal cancers will surpass cases of cervical cancer by 2020.)

In 2009, the FDA approved the HPV vaccine for young males. But when Fontenot tracked national data, she saw that few were receiving it. That’s when she began conducting focus groups with young males and found that most didn’t know about the vaccine or thought HPV was only a concern for women. When Fontenot and some of her colleagues reviewed medical records at the Borum Center, they found that just eight percent of the males had received at least one dose of the vaccine. (Two doses are required to protect boys aged 9 to 14; three doses for males aged 15 to 26.)

“If you look at the science, young gay men have probably the absolute lowest level of [HPV] vaccine rates as compared to any other group,” says Fontenot. That’s at least partly because the vaccine has an image problem, says one of Fontenot’s frequent collaborators, Gregory Zimet, Ph.D., a professor of pediatrics and clinical psychology at the Indiana University School of Medicine, who has conducted extensive research on attitudes about the HPV vaccine. “There is a common perception that the reason males should get the vaccine is to prevent HPV infections in girls,” says Zimet. “But YMSM don’t sleep with girls.”

Moreover, many of the patients Fontenot treats are homeless. “They have a lot of unique challenges and low levels of support—from family or society at large,” says Fontenot. Many are too busy finding a place to sleep to spend much time thinking about their health care, she says. Add the many other barriers she discovered in her focus groups, says Fontenot, and it’s hardly surprising that vaccination rates among YMSM are so low.

Fontenot has embraced the challenge of helping close the vaccination gap and others she sees in her clinical practice. “The fundamental issue that informs Holly’s work is a commitment to underserved populations,” says Kenneth Mayer, M.D., medical research director and co-chair of The Fenway Institute, a research arm of Fenway Health. Fontenot meets regularly with Mayer to discuss research ideas and the two have teamed with Penn State Assistant Professor of Biobehavioral Health Joshua Rosenberger, Ph.D., and Zimet to conduct the NIAID-funded initiative to develop and test an app to increase the number of YMSM who receive the HPV vaccination. “Holly is a phenomenal collaborator,” says Zimet. “She’s really smart and creative, but what sets her apart is her energy and positive outlook.”

The goal of the National Institute of Allergy and Infectious Diseases study is to create an app that promotes awareness of the HPV vaccine and makes it easier for young men to get it. Functions that are under development would help them make appointments at clinics, for example, and apply for insurance or financial assistance to cover costs. Once the study is completed next year, the app will be promoted on a social networking app. To find out what users might want and value in such an app, Fontenot has already conducted online focus groups that included young men in Boston, New York City, and Philadelphia. “The conversations were really rich. We got all kinds of great ideas,” says Fontenot, who suspects that participants may be more willing to share details about their intimate lives when typing on a computer or smartphone than seated at a conference table in a roomful of people.

Fontenot learned about conducting online focus groups from Rosenberger. Her newfound expertise, along with her skills working with young people, has raised her profile and increased demand for her as a scientific collaborator. She’s running online focus groups that will contribute key data to the CDC effort to develop tools and strategies for preventing HIV in YMSM. In that study, she’s collaborating with colleagues at the CDC, The Fenway Institute (where she now holds an adjunct faculty appointment), and the University of Chicago’s NORC research institute.

The goal of these focus groups will be to learn about the young participants’ awareness of HIV risk, access to sex education and methods for preventing HIV (such as condoms), and other relevant issues. Fontenot plays a similar role in the NIH/CFAR study, which will test whether YMSM are more likely to take the HIV-preventive drug combination known as PrEP if they have access to a “peer navigator,” which is a mentor or counselor who can provide emotional support and help them with practical matters such as filling prescriptions. PrEP, sold under the brand name Truvada, has been shown to reduce the risk of acquiring HIV by more than 90 percent. “We know HIV disproportionately affects youth and YMSM,” says Fontenot. Expanding the use of PrEP, she believes, “can transform HIV prevention.”

Fontenot is already helping to transform young lives. One of the greatest rewards of her work in the clinic, she says, is seeing her patients get off the street, find jobs, and f lourish. In her new and evolving role as a nurse scientist, she hopes to find innovative ways to eliminate health disparities that can prevent that from happening. “I want to keep pushing the science forward,” says Fontenot. “And keep young kids healthy.” ▪