54. CAPITALISING ON THE UNIQUE OPPORTUNITY OF THE HPV VACCINE, FOR A CERVICAL SCREENING PROGRAM

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 305
Author(s):  
L. Rawlings

The medical advancement of the human papilloma virus (HPV) vaccine and it's swift addition to the National Immunisation Program, caused a sudden surge in the public's awareness and interest in HPV. The challenge for PapScreen Victoria, a state based cervical screening program, was to react quickly and strategically to ensure that this new knowledge did not prevent women from having Pap tests. PapScreen pre-empted that the vaccine would have a huge impact on the current program, and undertook an educational journey to identify issues. The program sought expert opinions, formulated new partnerships in the immunisation sector and examined the current research. The program identified that its role was to inform women about HPV and the importance to continue screening in this new era of HPV vaccination. In the prevention of cervical cancer, there was also a role to inform health professionals, parents and young women about the benefits of the vaccine. The challenge was capatilising on the unique opportunity that the vaccine created. Developing and implementing strategies quickly was paramount in the program's success on capitalising this interest. Across three main areas - community, communications and research - the program implemented a range of strategies, including new resources, media opportunities, formative research and education, among others. PapScreen's aim was to remain the prime source of information for the prevention of cervical cancer in Victoria. The success of these strategies has been profound and immunisation messages are now included in all program messages across a range of sectors. The program was able to capitalise on this unique occasion by being flexible, proactive and strategically adaptable to the public health environment.

Cervical neoplasia provides an overview of the 4th most common malignancy in women worldwide, including the premalignant phase. Specific terminology used in cytology and histology (including atypia, dyskaryosis, cervical intraepithelial neoplasia (CIN), cervical glandular intraepithelial neoplasia (CGIN) and invasive cervical cancer (ICC) are explained, and the epidemiology and risk factors (with an emphasis on human papilloma virus (HPV)) for this common malignancy are included. Clinical presentation is outlined. Cervical screening is discussed, including the role of HPV testing, and both the British Association for Cytopathology/NHS cervical screening program 2013 classification of cervical cytology and the Bethesda system (used more widely worldwide) are explained. Diagnosis includes colposcopic examination of the cervix, and the management of both CIN and cervical cancer are included. HPV vaccination, pregnancy, and women living with HIV (including ICC as AIDS-defining) are discussed.


Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 328 ◽  
Author(s):  
Alison C. Budd ◽  
Christine J. Sturrock

Cytological and cancer surveillance will provide the most effective indications of short-term effects and long-term outcomes of the introduction of the human papillomavirus (HPV) vaccine in Australia. This article outlines how this surveillance is proposed to occur through the established national monitoring mechanisms of the National Cervical Screening Program in the annual Australian Institute of Health and Welfare (AIHW) publication ‘Cervical screening in Australia’. Cytological surveillance will be possible principally through cytology data provided annually by the state and territory cervical cytology registers, and it is expected that these data will provide the earliest and most comprehensive indications of effects from the HPV vaccine. Some potential issues in interpreting these data are also discussed, including the potentially confounding effects of the introduction of new National Health and Medical Research Council guidelines ‘Screening to prevent cervical cancer: guidelines for the management of asymptomatic women with screen-detected abnormalities’ some 9 months before the introduction of the vaccine. Cancer surveillance over the long term will be possible using cervical cancer incidence data reported annually for the National Cervical Screening Program in ‘Cervical screening in Australia’ using data sourced from the Australian Cancer Database. In a final discourse, the HPV vaccine and cervical screening are discussed concurrently, and the importance of continued cervical screening in the HPV vaccine era emphasised.


2018 ◽  
Vol 17 (3) ◽  
pp. 329-336
Author(s):  
Damitha Asanga Gunawardane

Human papillomavirus (HPV) causes cervical cancer, which is the fourth most common cancer in women. Most of the cervical cancers are linked to genital infection with HPV and it is the most common viral infection of the reproductive tract. At present, there are three types of HPV vaccines available. Even though HPV vaccination is a primary prevention tool, that does not eliminate the need for routine cervical screening, since the vaccines do not protect against all high-risk HPV types. Ninety percent of HPV infections have no clinical consequences at all whether they are high-risk or low-risk subtypes of HPV. All three types of HPV vaccines have very high vaccine efficacy for prevention of HPV infection among females aged 14 to 26 years. Proper assessment of the safety of HPV vaccine is a problem even after proper systematic review since the most of the clinical trials on the safety of the vaccines were used Hepatitis A vaccine or high immunogenicity enhancing aluminium adjuvant as their placebo. HPV vaccination would be very cost effective for the countries when there is no cervical screening program or if the programme coverage is very poor.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.329-336


2021 ◽  
Vol 24 (1) ◽  
pp. 51-57
Author(s):  
Catalina Diana Stanica ◽  
◽  
Romina Marina Sima ◽  
Raluca Gabriela Ioan ◽  
Constantin Dimitrie Nanu ◽  
...  

Worldwide, cervical cancer ranks 4th in frequency in the female population, with about half of the cases being fatal. In Romania, it is the second type of cancer found in women, after breast cancer and the main cause of cancer mortality in patients aged between 15 and 44 years. The main cause of this type of cancer is human papilloma virus (HPV) infection. Although HPV is very widespread (> 85%), progression to cervical cancer is relatively rare. In countries that have implemented cervical screening programs, the incidence and mortality caused by this pathology have decreased by 50-75%. Also, the emergence of vaccines against the most common strains of oncogenic HPV and the implementation of vaccination programs will bring additional benefits in preventing cervical cancer. This paper presents the results of a retrospective study, performed on a number of 92 patients, which aimed to know the distribution of different HPV genotypes, their impact on the cervical epithelium, the degree of access to the national screening program, and openness to anti HPV vaccination.


2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 55s-55s
Author(s):  
J. Bigaard ◽  
J.H. Mortensen ◽  
A.-B. Kvernrød

Background: In Denmark, the coverage rate for cervical cancer screening is about 75% for women aged 23 to 64 years whereas the participation rate is 65%. The participation rate varies with age, and is between 47%-57% among women in their twenties. In 2005, a qualitative study among women between 23 and 39 years found a range of barriers for nonparticipation. Barriers were lack of knowledge about the aim of cervical screening (i.e., the possibilities for early detection and treatment of cervical dysplasia), lack of knowledge about HPV as a very common virus causing dysplasia and cervical cancer and finding the time to make an appointment with the GP. 10 years later a follow-up study among women aged 30 to 50 years found similar barriers (i.e., lack of knowledge about HPV and cervical screening as a preventative method). Despite the different barriers, most women wanted to take part in screening, but a busy everyday life meant that they forgot about the invitation or they did not book an appointment with their GP. Aim: We investigated barriers for participation in the first generation of HPV-vaccinated women in Denmark aged 23 to 29 years. Methods: Qualitative interviews (focus groups) with women aged 23 to 29 years, who had all received one or more invitations to partake in cervical cancer screening, but who had not participated. Results: A preliminary analysis of the first six focus groups identified a handful of interrelated barriers similar to older women. The most important barrier being insufficient knowledge or lack of knowledge about HPV as the cause of dysplasia/cervical cancer (i.e., the high incidence of HPV-infection in women under the age of 35). Furthermore, few women knew about the screening program being an important supplement to their HPV-vaccine, and therefore did not find the program of relevance to them. Conclusion: Surprisingly, the preliminary results suggest important barriers for participation in cervical screening for women aged 23 to 29 to be insufficient knowledge or lack of knowledge about HPV-infection and the importance of regular smear tests as a supplement to their HPV-vaccine. The women did not perceive the smear test relevant enough to exert action and book an appointment with their GP. Barriers remained similar across age groups within the last 12 years despite health campaigns.


Author(s):  
Archana Nagendiram ◽  
Rachel Bidgood ◽  
Jennifer Banks ◽  
Clare Heal

2011 ◽  
pp. 108-115
Author(s):  
Vu Quoc Huy Nguyen

Persistent infection with high-risk Human Papilloma Virus (HPV) has been identified as the causal factor of cervical cancer, with relative risk up to 300-400 folds. This very close relationship leads to the preventive strategy of vaccination against HPV infections and HPV-related lesions. The article describes molecular and immunologic characteristics of HPV, currently available HPV vaccines and its protective effects; the relationship between HPV vaccination and cervical cancer screening, and an introduction to therapeutic HPV vaccine trials.


2020 ◽  
pp. 1114-1123
Author(s):  
Karen Yeates ◽  
Erica Erwin ◽  
Zac Mtema ◽  
Frank Magoti ◽  
Simoni Nkumbugwa ◽  
...  

PURPOSE Until human papillomavirus (HPV)–based cervical screening is more affordable and widely available, visual inspection with acetic acid (VIA) is recommended by the WHO for screening in lower-resource settings. Visual inspection will still be required to assess the cervix for women whose screening is positive for high-risk HPV. However, the quality of VIA can vary widely, and it is difficult to maintain a well-trained cadre of providers. We developed a smartphone-enhanced VIA platform (SEVIA) for real-time secure sharing of cervical images for remote supportive supervision, data monitoring, and evaluation. METHODS We assessed programmatic outcomes so that findings could be translated into routine care in the Tanzania National Cervical Cancer Prevention Program. We compared VIA positivity rates (for HIV-positive and HIV-negative women) before and after implementation. We collected demographic, diagnostic, treatment, and loss-to-follow-up data. RESULTS From July 2016 to June 2017, 10,545 women were screened using SEVIA at 24 health facilities across 5 regions of Tanzania. In the first 6 months of implementation, screening quality increased significantly from the baseline rate in the prior year, with a well-trained cadre of more than 50 health providers who “graduated” from the supportive-supervision training model. However, losses to follow-up for women referred for further evaluation or to a higher level of care were considerable. CONCLUSION The SEVIA platform is a feasible, quality improvement, mobile health intervention that can be integrated into a national cervical screening program. Our model demonstrates potential for scalability. As HPV screening becomes more affordable, the platform can be used for visual assessment of the cervix to determine amenability for same-day ablative therapy and/or as a secondary triage step, if needed.


Sexual Health ◽  
2007 ◽  
Vol 4 (3) ◽  
pp. 165 ◽  
Author(s):  
Shalini Kulasingam ◽  
Luke Connelly ◽  
Elizabeth Conway ◽  
Jane S. Hocking ◽  
Evan Myers ◽  
...  

Background: The cost-effectiveness of adding a human papillomavirus (HPV) vaccine to the Australian National Cervical Screening Program compared to screening alone was examined. Methods: A Markov model of the natural history of HPV infection that incorporates screening and vaccination was developed. A vaccine that prevents 100% of HPV 16/18-associated disease, with a lifetime duration of efficacy and 80% coverage offered through a school program to girls aged 12 years, in conjunction with current screening was compared with screening alone using cost (in Australian dollars) per life-year (LY) saved and quality-adjusted life-year (QALY) saved. Sensitivity analyses included determining the cost-effectiveness of offering a catch-up vaccination program to 14–26-year-olds and accounting for the benefits of herd immunity. Results: Vaccination with screening compared with screening alone was associated with an incremental cost-effectiveness ratio (ICER) of $51 103 per LY and $18 735 per QALY, assuming a cost per vaccine dose of $115. Results were sensitive to assumptions about the duration of vaccine efficacy, including the need for a booster ($68 158 per LY and $24 988 per QALY) to produce lifetime immunity. Accounting for herd immunity resulted in a more attractive ICER ($36 343 per LY and $13 316 per QALY) for girls only. The cost per LY of vaccinating boys and girls was $92 052 and the cost per QALY was $33 644. The cost per LY of implementing a catch-up vaccination program ranged from $45 652 ($16 727 per QALY) for extending vaccination to 14-year-olds to $78 702 ($34 536 per QALY) for 26-year-olds. Conclusions: These results suggest that adding an HPV vaccine to Australia’s current screening regimen is a potentially cost-effective way to reduce cervical cancer and the clinical interventions that are currently associated with its prevention via screening alone.


Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 496
Author(s):  
Caroline Deignan ◽  
Alison Swartz ◽  
Sara Cooper ◽  
Christopher J. Colvin

Cervical cancer rates in Sub-Saharan Africa (SSA) are amongst the highest worldwide. All three of the Human Papillomavirus (HPV) vaccines (9-valent, quadrivalent and bivalent HPV vaccine) provide primary protection against the most common cancer-causing strains of HPV (types 16 and 18) that are known to cause 70% of cervical cancers. Over the last five years, there has been an increase in Sub-Saharan African countries that have introduced the HPV vaccine. The majority of research has been conducted on supply-side barriers and facilitators to HPV vaccination uptake in SSA, yet little research has been conducted on demand-side or end-user perspectives of, and decisions around, HPV vaccination. In order to complement existing research, and inform current and future HPV vaccination implementation approaches, this qualitative systematic review explored Stakeholders’ understandings of HPV vaccination in SSA. This review searched the following databases: Embase (via Scopus), Scopus, MEDLINE (via PubMed), PubMed, EBSCOhost, Academic Search Premier, Africa-Wide Information, CINAHL, PsycARTICLES, PsycINFO, SocINDEX, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) and found a total of 259 articles. Thirty-one studies were found eligible for inclusion and were analyzed thematically using Braun and Clarke’s methods for conducting a thematic analysis. The quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Three major themes emerged from this analysis; knowledge of HPV vaccination and cervical cancer is intertwined with misinformation; fear has shaped contradictory perceptions about HPV vaccination and gender dynamics are relevant in how stakeholders understand HPV vaccination in SSA.


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