Mapping HPV Vaccination and Cervical Cancer Screening Practice in the Pacific Region-Strengthening National and Regional Cervical Cancer Prevention.

J Obel,D Hoy,Y Souares,J Mckenzie,Sm Garland,Sk Kjaer,A Roth,W Baravilala,Le Buenconsejo-Lum,Am Durand,A Ekeroma

doi:10.7314/apjcp.2015.16.8.3435

Abstract

To provide background information for strengthening cervical cancer prevention in the Pacific by mapping current human papillomavirus (HPV) vaccination and cervical cancer screening practices, as well as intent and barriers to the introduction and maintenance of national HPV vaccination programmes in the region. A cross-sectional questionnaire-based survey among ministry of health officials from 21 Pacific Island countries and territories (n=21). Cervical cancer prevention was rated as highly important, but implementation of prevention programs were insufficient, with only two of 21 countries and territories having achieved coverage of cervical cancer screening above 40%. Ten of 21 countries and territories had included HPV vaccination in their immunization schedule, but only two countries reported coverage of HPV vaccination above 60% among the targeted population. Key barriers to the introduction and continuation of HPV vaccination were reported to be: (i) Lack of sustainable financing for HPV vaccine programs; (ii) Lack of visible government endorsement; (iii) Critical public perception of the value and safety of the HPV vaccine; and (iv) Lack of clear guidelines and policies for HPV vaccination. Current practices to prevent cervical cancer in the Pacific Region do not match the high burden of disease from cervical cancer. A regional approach, including reducing vaccine prices by bulk purchase of vaccine, technical support for implementation of prevention programs, operational research and advocacy could strengthen political momentum for cervical cancer prevention and avoid risking the lives of many women in the Pacific.

Highlights

Infection with oncogenic types of the sexually transmitted human papillomavirus (HPV) is a prerequisite for the development of cervical cancer (Walboomers et al, 1999)
Questionnaires: 3 countries (Tuvalu, Wallis within the Pacific Region. 10 countries and territories and Futuna and Marshall Islands) did not respond to the (New Caledonia, Cook Islands, FSM, Fiji, Guam, questions regarding the perceived importance of screening Kiribati, Wallis and Futuna, Marshall Islands, Northern and vaccination, whilst 5 countries did not rate the barriers Mariana Islands and Palau) reported HPV vaccination to HPV vaccination
Three countries (American Samoa, Nauru and Vanuatu) had not yet started to implement national vaccination but Cervical cancer screening practices in the pacific region Ministry of Health officials reported that a national HPV

Summary

Introduction

Infection with oncogenic types of the sexually transmitted human papillomavirus (HPV) is a prerequisite for the development of cervical cancer (Walboomers et al, 1999). Of the 528,000 new cervical cancer cases globally each year, 85% occur in low-income countries, where it ranges between the first to fourth most common type of cancer in women (Ferlay et al, 2015). Despite the existence of evidence based primary and secondary prevention measures, 266,000 women die throughout the world each year from cervical cancer. Primary prevention by high coverage of vaccination against the highly prevalent oncogenic HPV genotypes 16 and 18 among girls before sexual debut has the potential to reduce the global burden of cervical cancer by 70-80% (WHO, 2009). Secondary prevention by screening and treatment of pre-cancerous lesions in young and middle aged women has been shown to reduce the incidence of and mortality from cervical cancer substantially in countries with well established health systems and has recently been demonstrated to be effective in low-income countries (Denny and Anorlu, 2012)

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