Modeling studies suggest that

STI CAL-101 clinical trial vaccination should be broadly implemented in order to have a large public health impact [15]. HCP recommendation may be especially important for STI vaccine uptake among adolescents most Libraries vulnerable to non- or under-vaccination, including those with poor access to care (i.e., often racial/ethnic minorities) [12] and [16] and cultural barriers (i.e., select religious groups) [17]. Adolescents with chronic medical conditions may also be vulnerable given misinformation about disease risk and vaccine contraindications [17] and [18]. Many identify a subspecialist as their main HCP [19], which may pose additional challenges for STI vaccination. HCP recommendations may also have a particular impact in settings that use a clinic-based delivery model compared to settings that use a school-based delivery model. However, since school absenteeism can be a challenge for school-based vaccination programs, especially in resource-poor areas [17], [20] and [21], health centers may be used to complement the school-based

vaccination programs, as demonstrated by HPV vaccination programs in countries such as Vietnam and India [20]. Despite strong evidence that recommending STI vaccination of adolescents Epacadostat has a positive impact on uptake, many HCPs fail to do so. Survey studies of physicians from Asia

and Australia have shown that only half initiate conversations about else HPV vaccination [7] and [22]. Moreover, one-quarter to one-half of HCPs across disciplines and countries report that they do not routinely recommend HPV vaccination [23] and [24]. Physicians may also believe they are recommending the vaccine more than parents are “hearing” it being recommended. A study conducted in Los Angeles County found that only 30% of parents reported that a HCP recommended HPV vaccination for their adolescent daughter [12]. For HCPs who engage in a conversation about STI vaccines with their patients, it is important to understand what they are communicating and how it influences STI vaccine uptake. Several studies have explored whether messages should emphasize universal infection risk and/or non-sexual transmission modes in order to de-stigmatize STI vaccination [25], [26], [27] and [28]. In the United States, hepatitis B vaccine messaging by HCPs and others was adapted over time to reduce STI-related stigma, and this likely contributed to a simultaneous rise in hepatitis B vaccination coverage [25]. Similarly, many HCPs have chosen to emphasize cancer prevention when discussing HPV vaccination [29], [30] and [31]. It remains unclear if this is warranted based upon adolescent and parental concerns.