1. Evaluation of Immunization Delivery Services in Rural Alaska Kira M. Mori, BA Public Health Associate PHAP Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2015 PHAP/PHPS Summer Seminar June 2, 2015 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. Importance of Immunizations  Among children born during 1994–2013 in the U.S., vaccination will prevent an estimated:  322 million illnesses  21 million hospitalizations  732,000 deaths  Estimated vaccination coverage with combined vaccine series among children 19-35 months  United States, 2013: 70.4% (±1.5)  Alaska, 2013: 63.9% (±6.8) * http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6334a1.htm?s_cid=mm6334a1_w, http://www.cdc.gov/vaccines/vac-gen/whatifstop.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6334a1.htm?s_cid=mm6334a1_whttp://www.cdc.gov/vaccines/vac-gen/whatifstop.htm Nome museum, news about diphtheria epidemic that used dog sleds for the ‘1925 serum run’

3. Alaska: The Last Frontier  Largest and most sparsely populated state in the U.S.  2014 population estimate of 736,732 individuals 40% of Alaska’s population live in Anchorage o Northern regions may experience winter temperatures reaching below -50 degrees Fahrenheit o Remote communities are inaccessible by road systems * www.usmarshals.gov/district/ak/general/information.htm, www.quickfacts.census.govwww.usmarshals.gov/district/ak/general/information.htmwww.quickfacts.census.gov

4. Significance to Public Health  To improve processes influencing the effectiveness of immunization delivery services in rural Alaska  Harsh terrain, climate, and geography impacting transportability of immunizations Immunization delivery is a time sensitive process Requires multi-faceted practices through the coordination of efforts Cargo planes used for transporting immunizations from Anchorage to outside facilities

5.  Tribal Hubs  Servicing Alaska native villages with small populations  Tribal hubs order immunizations from depot then redistribute to tribal clinics  Vaccine Depot  Alaska is unique in that it has a centralized depot in Anchorage where pharmaceuticals deliver bulk vaccine Operated by the Alaska Department of Health and Social Services  Healthcare providers order select vaccine that is then distributed from the depot to ‘tribal hubs’ Background and Rationale Walk-in refrigerator used for vaccine storage at depot Examining shipment of HPV vaccine

6. *Akchap.org  CHAP  Alaska Community Health Aide Program Network of community health aides/practitioners servicing more than 170 rural communities in Alaska  Health care providers serving as vaccine coordinators  Vaccine coordinators located at primary vaccine “hubs” Work closely with the state to facilitate immunization delivery processes to tribal hubs from Vaccine depot Background and Rationale

7. Methods  Process evaluation  Semi-structured, in-depth key informant interviews conducted at nine tribal health corporations Traveled to eight remote communities to meet with health care providers o Utilized a formatted Adobe fillable questionnaire of 40 questions to collect information o Collected responses identified: current practices, educational training for staff, delivery systems, documentation processes, and barriers to effective immunization delivery

8. Qualitative Analysis  NVivo  Thematically coded collected data Data cleaning Imported responses into program  Identifying common themes  Text frequency Word frequency used to evaluate common themes per each question Word group queries and text coding used to map word trees and select for word groups

9.  Results  All respondents identified six common barriers to effective immunization delivery services in rural Alaska Common barriers: Low retention rates of CHAPs, limited accessibility to resources, limited funding, climatic constraints, lack of knowledge of best practices, and communication barriers between vaccine coordinators and CHAPs o Three sites identified inconsistent access to electricity and internet o One site identified lack of leadership support Norton Sound in Nome, AK Samuel Simmons Memorial Hospital in Barrow, AK Yukon Kuskokwim Health Corporation in Bethel, AK

10. Implications for Practice  Due to the uniqueness of Alaska, the immunization delivery service infrastructure is incomparable across the nation  Results may be used to: Improve immunization delivery services in Alaska Increase access to other healthcare services in remote areas of Alaska Arctic Ocean in Barrow, AK Barrow neighborhoods

11. Improving immunization delivery services and increasing access to medical services in remote areas of Alaska Dillingham Public Health Center in Dillingham, AK

12. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Questions? Kira M. Mori, BA Public Health Associate CDC/OSTLTS/PHAP 3601 C Street, Suite 540 Anchorage, AK 99503 (907) 269-8036 ypb0@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support