JAMA Pediatrics
July 2015, Vol 169, No. 7
http://archpedi.jamanetwork.com/issue.aspx

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Viewpoint
Time to Improve the Global Human Immunodeficiency Virus/AIDS Care Continuum for Adolescents: A Generation at Stake
Sarah M. Wood, MD, AAHIVS; Nadia Dowshen, MD, AAHIVS; Elizabeth Lowenthal, MD, MSCE, AAHIVS
Extract
This Viewpoint discusses the importance of improving care globally for adolescents with human immunodeficiency virus (HIV)/AIDS.
Pediatricians have an obligation to protect the health of children and adolescents. Human immunodeficiency virus (HIV)/AIDS remains the second leading cause of death for adolescents worldwide and the leading cause for adolescents in sub-Saharan Africa.1 Youth aged 15 to 24 years represent one-third of new infections.2 While AIDS-related mortality declined for adults and children from 2005 to 2012, there was a 50% increase in mortality among HIV-infected adolescents.2 For perinatally HIV-infected youth, worse outcomes largely reflect developmental struggles with treatment adherence they face as they enter adolescence. For adolescents with behaviorally acquired HIV, late diagnosis, poor linkage to and retention in care, low rates of antiretroviral therapy (ART) prescription, and inadequate treatment adherence all affect mortality.2 In the United States, nearly 60% of HIV-infected youth do not know they are infected.3 In sub-Saharan Africa, only 1 in 5 HIV-infected young women knows her status…

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International Child Health Competencies
Meaghann Shaw Weaver, MD, MPHc; Liza-Marie Johnson, MD, MSB, MPH
Extract
This Viewpoint reports that global health outreach partnerships with a bioethical foundation have the potential for immense societal benefit, personal growth, and professional enhancement for pediatric trainees.
Well-guided, sustainable global health outreach partnerships have the potential for immense societal benefit, personal growth, and professional enhancement for pediatric trainees. Yet, international pursuits lacking a bioethical foundation risk harming medically underserved populations and learners. Determining ethical competency in overseas training efforts rests on whether the pursuit is one of clinical skills practice or one of purposeful praxis (reflective experiential learning). Aristotle honored praxis as the highest form of knowledge, a practical knowledge; later philosophers used praxis to describe a shift from mindful reflection to social improvement. We define international child health praxis as a mentored, ethical approach that acknowledges system barriers, strives for solidarity with local stakeholders, and partners with them toward population wellness…

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Remembering the Benefits of Vaccination
Kristen A. Feemster, MD, MPH, MSHP
Extract
Between 2009 and 2012, 36 bills were introduced in 18 states to change vaccine exemption laws related to school-entry requirements. Of the 31 bills that sought to loosen requirements for obtaining an exemption, none passed.1 Fortunately, the clear evidence showing that easy exemption laws lead to higher exemption rates and higher exemption rates lead to outbreaks of vaccine-preventable diseases was well-heeded.2- 5 Further proof is now visible as we face the largest number of measles cases in the United States since the disease was declared eliminated in 2000, including a large ongoing outbreak associated with Disneyland that has affected more than 140 individuals.6 Most measles cases are among unvaccinated children whose parents refused the measles, mumps, and rubella vaccine because of philosophical or religious beliefs. Since January 2015, legislators in at least 8 states have introduced bills to tighten exemptions to mandatory school-entry vaccination policies.7 The reemergence of measles has raised a sense of urgency and voices in support of vaccination have become much louder…

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Invasive Pneumococcal Disease Following the Introduction of 13-Valent Conjugate Vaccine in Children in New York City From 2007 to 2012
Andrea C. Farnham, MPH; Christopher M. Zimmerman, MD, MPH; Vikki Papadouka, PhD, MPH; Kevin J. Konty, MS, MA; Jane R. Zucker, MD, MSc; Geetha V. Nattanmai, BS, MT, MS; Sherly Jose, AAS, CLT; Jennifer B. Rosen, MD
Practice- and Community-Based Interventions to Increase Human Papillomavirus Vaccine Coverage: A Systematic Review
Linda M. Niccolai, PhD; Caitlin E. Hansen, MD
Abstract
Importance
Vaccines against human papillomavirus (HPV) are recommended for routine use in adolescents aged 11 to 12 years in the United States, but uptake remains suboptimal. Educational interventions focused on parents and patients to increase coverage have not generally demonstrated effectiveness.
Objective
To systematically review the literature on effectiveness of interventions conducted at the practice or community level to increase uptake of HPV vaccines in the United States.
Evidence Review
Keyword searches of the PubMed, Web of Science, and MEDLINE databases identified studies of adolescents that included the outcome of HPV vaccination published through July 2014. References of identified articles were also reviewed. A total of 366 records were screened, 38 full-text articles were reviewed, and 14 published studies were included. Results were summarized by different intervention approaches.
Findings
Practice- and community-based intervention approaches included reminder and recall (n = 7), physician-focused interventions (eg, audit and feedback) (n = 6), school-based programs (n = 2), and social marketing (n = 2) (2 interventions tested multiple approaches). Seven studies used a randomized design, and 8 used quasiexperimental approaches (one used both). Thirteen studies included girls, and 2 studies included boys. Studies were conducted in a variety of populations and geographic locations. Twelve studies reported significant increases in at least one HPV vaccination outcome, one reported a nonsignificant increase, and one reported mixed effects.
Conclusions and Relevance
Most practice- and community-based interventions significantly increased HPV vaccination rates using varied approaches across diverse populations. This finding is in stark contrast to a recent review that did not find effects to warrant widespread implementation for any educational intervention. To address the current suboptimal rates of HPV vaccination in the United States, future efforts should focus on programs that can be implemented within health care settings, such as reminder and recall strategies and physician-focused efforts, as well as the use of alternative community-based locations, such as schools.