scholarly journals Human Papillomavirus and Oropharyngeal Cancer Among Indigenous Australians: Protocol for a Prevalence Study of Oral-Related Human Papillomavirus and Cost-Effectiveness of Prevention (Preprint)

2018 ◽  
Author(s):  
Lisa Jamieson ◽  
Gail Garvey ◽  
Joanne Hedges ◽  
Amanda Mitchell ◽  
Terry Dunbar ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Cost Effectiveness ◽  
High Risk ◽  
Oropharyngeal Cancer ◽  
Torres Strait Islander ◽  
Hpv Vaccination ◽  
Health State ◽  
Torres Strait ◽  
The Impact

BACKGROUND Oropharyngeal cancer is an important, understudied cancer affecting Aboriginal and Torres Strait Islander Australians. The human papillomavirus (HPV) is a significant risk factor for oropharyngeal cancer. Current generation HPV vaccines are effective against the 2 most common types of high-risk HPVs in cancer (hrHPVs 16/18). OBJECTIVES This study aims (1) to yield population estimates of oncogenic genotypes of HPV in the mouth and oropharynx of defined Aboriginal and Torres Strait Islander populations; (2) to estimate the proportion of oropharyngeal cancer attributable to HPV among these Australian citizens; (3) to estimate the impact of HPV vaccination as currently implemented on rates of oropharyngeal cancer among Aboriginal and Torres Strait Islander Australians; and (4) taking into account impact on oropharyngeal as well as cervical cancer, to evaluate efficacy and cost-effectiveness of targeted extended HPV vaccination to older ages, among our study population. METHODS Our study design and operation is straightforward, with minimal impost on participants. It involves testing for carriage of hrHPV in the mouth and oropharynx among 1000 Aboriginal South Australians by simple saliva collection and with follow-up at 12 and 24 months, collection of sexual history at baseline, collection of information for estimating health state (quality-of-life) utilities at baseline, genotyping of viruses, predictive outcome and cost-effectiveness modeling, data interpretation and development of vaccination, and follow-up management strategies driven by the Aboriginal community. RESULTS Participant recruitment for this study commenced in February 2018 and enrollment is ongoing. The first results are expected to be submitted for publication in 2019. CONCLUSIONS The project will have a number of important outcomes. Synthesis of evidence will enable generation of estimates of the burden of oropharyngeal cancer among Aboriginal and Torres Strait Islander Australians and indicate the likely effectiveness and cost-effectiveness of prevention. This will be important for health services planning, and for Aboriginal health worker and patient education. The results will also point to important areas where research efforts should be focused to improve outcomes in Aboriginal and Torres Strait Islander Australians with oropharyngeal cancer. There will be a strong focus on community engagement and accounting for the preferences of individuals and the community in control of HPV-related cancers. The project has international relevance in that it will be the first to systematically evaluate prevention of both cervical and oropharyngeal cancer in a high-risk Indigenous population taking into account all population, testing, and surveillance options. REGISTERED REPORT IDENTIFIER RR1-10.2196/10503

Factors influencing rates of human papillomavirus vaccination

2019 ◽  
Author(s):  
Kelsey E Palmer ◽  
Krystal L Moorman ◽  
Nancy A Nickman ◽  
David G Owen
Keyword(s):  
Human Papillomavirus ◽  
Failure Modes ◽  
Hpv Vaccination ◽  
Care Process ◽  
Quality Improvement Initiative ◽  
Human Papillomavirus Vaccination ◽  
Community Clinic ◽  
Process Improvements ◽  
The Impact

Abstract Purpose Failure modes and effects analysis (FMEA) was used to identify ways in which community clinic practices related to suboptimal human papillomavirus (HPV) vaccination rates could be improved. Method FMEA is a standardized safety method that helps determine where processes fail, the impact of failures, and needed process changes. In a quality improvement initiative conducted at an academic health center–based community clinic, a multidisciplinary team used FMEA to map HPV vaccination processes and identify areas for improvement of vaccination practices. Risk priority numbers (RPNs) were assigned to identified failure modes based on likelihood of occurrence, likelihood of detection, and ability to correct locally. Failure modes with the highest RPNs were targeted for process improvements. Results High RPN failure modes were related to clinic processes for follow-up, immunization status checks during well-child visits, and vaccination discussions during sick-child visits. New procedures included scheduling follow-up vaccinations and reminders during the initial vaccination appointment. HPV immunization rates improved following implementation of these procedures, indicating that clinic processes focused on patient follow-up can impact vaccination series completion. Conclusion FMEA processes can help health systems identify workflow barriers and locally relevant opportunities for improvement. Team-based approaches to care process improvements can also benefit from standardized problem identification and solving.

scholarly journals Awareness of oral and genital human papillomavirus (HPV) infection in young adolescents prior to gender-neutral vaccination

2020 ◽  
pp. bmjsrh-2019-200410
Author(s):  
Gillian Knight ◽  
Ben Roberts
Keyword(s):  
Human Papillomavirus ◽  
Oropharyngeal Cancer ◽  
Healthcare Professionals ◽  
Hpv Vaccination ◽  
Intervention Strategy ◽  
Hpv Infection ◽  
Similar Proportion ◽  
Transmitted Infection ◽  
Oral Hpv ◽  
The Impact

IntroductionOral human papillomavirus (HPV) and oropharyngeal cancer prevalence are increasing, particularly in men. Raising greater awareness of male HPV disease is perceived as an important intervention strategy. This study investigated the effectiveness of HPV education on adolescents’ perception of HPV disease and the impact of HPV vaccination on their sexual health.MethodsAn HPV questionnaire was completed by 357 UK-based adolescents, aged 12–13 years.ResultsMost adolescents knew HPV causes cervical cancer and HPV vaccination prevents this. A minority acknowledged HPV causes other genital cancers, with under one-fifth knowing HPV causes genital warts. Adolescents’ awareness of HPV transmission activities were limited. There was very poor awareness of oral HPV infection or HPV-induced oropharyngeal cancer. Half of the participants stated HPV vaccination reduced their concerns about sexually transmitted infection contraction. Over half the males said they may take more sexual risks following vaccination, while a similar proportion of females did not expect their partner to take more risks.ConclusionsAdolescents had little awareness of male HPV infection and the role HPV vaccination can play in preventing these diseases. With variable rates of HPV vaccination uptake in males reported worldwide, this study indicates that in the UK greater emphasis on male HPV disease within educational information is required, to raise better awareness of how HPV affects both genders. As both genders preferred to receive education via healthcare professionals, educating a wider range of healthcare professionals on oral HPV could help facilitate awareness of HPV’s role in head and neck cancer.

scholarly journals Cohort profile: indigenous human papillomavirus and oropharyngeal squamous cell carcinoma study - a prospective longitudinal cohort

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046928
Author(s):  
Lisa M Jamieson ◽  
Gail Garvey ◽  
Joanne Hedges ◽  
Cathy Leane ◽  
Isaac Hill ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Human Papillomavirus ◽  
Hpv Vaccination ◽  
Hpv Infection ◽  
Indigenous Australians ◽  
Health State ◽  
Hpv 16 ◽  
Oral Hpv ◽  
Hpv Types

PurposeOur aims are to: (1) estimate prevalence, incidence, clearance and persistence of oral human papillomavirus (HPV) infection among Indigenous Australians; (2) identify risk factors associated with oropharyngeal squamous cell carcinoma (OPSCC)-related HPV types (HPV 16 or 18); (3) develop HPV-related health state valuations and; (4) determine the impact on OPSCC and cervical cancers, and the cost-effectiveness of extending publicly-funded HPV vaccination among Indigenous Australians.ParticipantsParticipants were recruited from February 2018 to January 2019. Twelve-month follow-up occurred from March 2019 to March 2020. Participants provided socio-demographic characteristics, health-related behaviours including tobacco and alcohol use and sexual history. Health state preferences in regard to HPV vaccination, knowledge regarding HPV infection, OPSCC and cervical cancer were collected using a two-stage standard gamble approach. Participants provided saliva samples and DNA for microbial genotyping was extracted.Findings to dateOf the 910 participants who were positive for β-globin at baseline, 35% had any oral HPV infection. The most prevalent HPV types were 13 or 32 (Heck’s disease; 23%). The second most prevalent types were associated with OPSCC (HPV 16 or 18; 3.3%). Of the 645 participants who were positive for β-globin at 12-month follow-up, 43% had any HPV infection. Of these, 33% were HPV types 13 or 32 and 2.5% were HPV 16 or 18. Some 588 participants had β-globin positive oral samples at baseline and 12-month follow-up. The prevalence of any oral HPV infection increased from 34% at baseline to 44% at 12-month follow-up; due to increases in HPV types 13 or 32 (20% at baseline and 34% at 12-month follow-up).Future plansFurther funding will be sought to continue follow-up of this cohort, and to include (after a full medical history) a thorough clinical examination of the external head and neck; a complete oral examination and examination of the oropharynx. Blood tests for early stage OPSCC will also be undertaken.

A preliminary cost-effectiveness analysis of human papillomavirus vaccination in males for the prevention of oropharyngeal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6033-6033 ◽  
Author(s):  
Donna M. Graham ◽  
Wanrudee Isaranuwatchai ◽  
Steven Habbous ◽  
Claire de Oliveira ◽  
Geoffrey Liu ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Cost Effectiveness ◽  
Vaccine Efficacy ◽  
Oropharyngeal Cancer ◽  
Hpv Vaccine ◽  
Hpv Vaccination ◽  
Cost Effectiveness Analysis ◽  
Cervix Cancer ◽  
Vaccine Uptake ◽  
Effectiveness Analysis

6033 Background: Many western countries have established female human papillomavirus (HPV) vaccination programmes for prevention of cervix cancer. Efficacy against additional HPV-related disease is proven in both sexes, but cost-effectiveness of male vaccination remains controversial. Projected figures suggest incidence and prevalence of oropharyngeal cancer (OPC) in North America will exceed that of cervix cancer by 2020 due to HPV-related cases. Two cost-effectiveness analyses evaluating male HPV vaccination have included OPC, with contrasting results. The Canadian government recommends, but does not fund, male vaccination. In order to assess the value for money of male HPV vaccination in Canada with respect to OPC, we performed a preliminary cost-effectiveness analysis. Methods: Following extensive literature review regarding HPV-related OPC in Canadian males, healthcare cost and clinical effectiveness estimates were obtained from published studies. A Markov model was used to compare potential costs and effectiveness of HPV vaccination against no vaccination among males aged 12 years old. A 3-month cycle length was used with a ‘lifetime’ time horizon. The outcome of the analysis was the incremental cost per quality-adjusted life-year (QALY). Sensitivity analyses were conducted on variables such as vaccine uptake rate and efficacy. Results: Assuming 99% vaccine efficacy and 70% uptake, the use of HPV vaccine produced 0.05 more QALYs and saved $204 Canadian dollars (CAD) per person compared with no vaccine (QALYs and costs discounted at 5% per year). Assuming 50% vaccine efficacy and 50% uptake, use of HPV vaccine produced 0.01 more QALYs and saved $43 CAD. Based on a population of 12 year old males of 192,940 in 2012, male HPV vaccination may potentially save $8.3-39.4 million CAD for this cohort over its lifetime. Conclusions: Knowledge gaps exist regarding male HPV vaccination for OPC prevention. Due to practical limitations, including lack of identifiable precursor lesions in OPC, clinical trials to evaluate this issue may not be feasible. Without considering the effects of herd immunity, this preliminary analysis highlights potential savings from male vaccination.

scholarly journals Release of the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025; the impacts for podiatry in Australia: a commentary

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
James M. Gerrard ◽  
Shirley Godwin ◽  
Vivienne Chuter ◽  
Shannon E. Munteanu ◽  
Matthew West ◽  
...  
Keyword(s):  
Health Outcomes ◽  
First Nations ◽  
Torres Strait Islander ◽  
Collective Responsibility ◽  
Cultural Safety ◽  
Main Body ◽  
Torres Strait ◽  
The Impact ◽  
Torres Strait Islander Health ◽  
Safety Strategy

Abstract Background Developing since colonisation, Australia’s healthcare system has dismissed an ongoing and successful First Nations health paradigm in place for 60,000 years. From Captain James Cook documenting ‘very old’ First Nations Peoples being ‘far more happier than we Europeans’ and Governor Arthur Phillip naming Manly in admiration of the physical health of Gadigal men of the Eora Nation, to anthropologist Daisy Bates’ observation of First Nations Peoples living ‘into their eighties’ and having a higher life expectancy than Europeans; our healthcare system’s shameful cultural safety deficit has allowed for an Aboriginal and Torres Strait Islander child born in Australia today to expect to live 9 years less than a non-Indigenous child. Disproportionately negative healthcare outcomes including early onset diabetes-related foot disease and high rates of lower limb amputation in Aboriginal and Torres Strait Islander Peoples contribute to this gross inequity. Main body In 2020, the Australian Health Practitioner Regulation Authority released the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020–2025 - empowering all registered health practitioners within Australia to provide health care to Aboriginal and Torres Strait Islander Peoples that is inclusive, respectful and safe, as judged by the recipient of care. This recently released strategy is critically important to the podiatry profession in Australia. As clinicians, researchers and educators we have a collective responsibility to engage with this strategy of cultural safety. This commentary defines cultural safety for podiatry and outlines the components of the strategy in the context of our profession. Discussion considers the impact of the strategy on podiatry. It identifies mechanisms for podiatrists in all settings to facilitate safer practice, thereby advancing healthcare to produce more equitable outcomes. Conclusion Aboriginal and Torres Strait Islander Peoples access health services more frequently and have better health outcomes where provision of care is culturally safe. By engaging with the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy, all registered podiatrists in Australia can contribute to achieving equity in health outcomes for Aboriginal and Torres Strait Islander Peoples.

Impact of specific high‐risk human papillomavirus genotypes on survival in oropharyngeal cancer

2021 ◽  
Author(s):  
Martin Garset‐Zamani ◽  
Amanda F. Carlander ◽  
Kathrine K. Jakobsen ◽  
Jeppe Friborg ◽  
Katalin Kiss ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
High Risk ◽  
Oropharyngeal Cancer

scholarly journals The road beyond licensing: the impact of a driver licensing support program on employment outcomes for Aboriginal and Torres Strait Islander Australians

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bobby Porykali ◽  
Patricia Cullen ◽  
Kate Hunter ◽  
Kris Rogers ◽  
Melissa Kang ◽  
...  
Keyword(s):  
Urban Areas ◽  
Torres Strait Islander ◽  
Geographical Area ◽  
Employment Outcomes ◽  
Support Program ◽  
The Road ◽  
Regional Area ◽  
Torres Strait ◽  
The Impact ◽  
Driver Licensing

Abstract Background With increasingly tough graduated driver licensing laws in all Australian States and Territories, driver licensing support programs are recognised as being important to support Aboriginal and Torres Strait Islander peoples to obtain a driver licence. Such programs appear to improve licensing attainment rates, but few studies have examined the broader impact that these programs can have. This research aims to 1) examine the impact of a New South Wales (NSW) based driver licensing support program (Driving Change) on client employment outcomes; 2) assess the influence of geographical area of program delivery on driver licence attainment. Methods Driving Change was delivered from February 2013 to August 2016 in 4 urban and 7 regional Aboriginal communities of NSW. Clients were followed-up at 6 months or more following contact with the program as part of routine program operations. Descriptive statistics and regression models were used to analyse data. Results From 933 clients contacted 254 agreed to provide feedback, a response rate of 27%. Those that responded were mostly female (57%), aged 24 years and under (72%), unemployed (85%) with secondary education or less (71%) and from a regional area (74%). Adjusted logistic regression indicated that clients who achieved an independent licence were more likely (OR: 2.5, 95% CI: 1.22–5.24, p = 0.011) of reporting a new job or change in job than those who did not attain a licence. Clients from regional areas were more likely (OR: 1.72, 95% CI: 1.27–2.33, p < 0.001) to gain an independent licence than those from urban areas. There was no difference in employment outcomes (OR: 1.2, 95% CI: 0.53–2.52, p = 0.719) for clients from urban compared to regional areas. Conclusion The Driving Change program appears to be effective in improving employment outcomes for those who gained a licence. Clients from regional areas were more likely to gain a licence compared to those in urban settings, and were predominantly young and unemployed, often a hard to reach cohort. Future licensing programs being delivered in regional areas need integrated pathways into employment opportunities to provide holistic services that address the social and economic challenges faced by Aboriginal and Torres Strait Islander Australians.

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