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Palmer M, Katanoda K, Saito E, Acuti Martellucci C, Tanaka S, Ikeda S, Sakamoto H, Machalek D, Brotherton JML, Hocking JS. Corrigendum to "Genotype prevalence and age distribution of human papillomavirus from infection to cervical cancer in Japanese women: A systematic review and meta-analysis" [Vaccine 40(41) (2022) 5971-5996]. Vaccine 2023; 41:6135. [PMID: 37659892 DOI: 10.1016/j.vaccine.2023.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Affiliation(s)
- Matthew Palmer
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia; Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan.
| | - Kota Katanoda
- Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Eiko Saito
- Institute for Global Health Policy Research, National Center for Global Health Medicine, Tokyo, Japan
| | | | - Shiori Tanaka
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Division of Prevention, Center for Public Health Sciences, National Cancer Center, Japan
| | - Sayaka Ikeda
- Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Haruka Sakamoto
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Julia M L Brotherton
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia; Australian Centre for the Prevention of Cervical Cancer, Carlton, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia
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Oommen AM, Basu P, Cherian AG, Zomawia E, Manoharan R, Pricilla RA, Viswanathan V, Oldenburg B, Subramanian S, Hawkes D, Saville M, Brotherton JML. Protocol for the formative phase of a trial (SHE-CAN) to test co-designed implementation strategies for HPV-based cervical screening among vulnerable women in two diverse settings in India. Implement Sci Commun 2023; 4:62. [PMID: 37291627 PMCID: PMC10249153 DOI: 10.1186/s43058-023-00436-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND In view of the WHO's call for the elimination of cervical cancer as a public health problem, and current low screening coverage, Indian policy makers need evidence on how to effectively implement cervical screening programmes, ensuring equity in access. Our study will follow the INSPIRE implementation framework to co-design and test HPV-based screening approaches in two states of India with different health system organisation, based on understanding the status of screening as currently implemented, readiness and challenges to transition to HPV-based screening, and preferences of key stakeholders. Here, we describe our protocol for the formative phase of the study (SHE-CAN). METHODS The study population includes women from vulnerable populations, defined as residents of tribal areas, rural villages, and urban slums, in the states of Mizoram and Tamil Nadu. The baseline assessment will use mixed methods research, with desktop reviews, qualitative studies, and surveys. A capacity assessment survey of screening and treatment facilities will be done, followed by interviews with healthcare providers, programme managers, and community health workers. Interviews will be conducted with previously screened women and focus group discussions with under and never-screened women and community members. Stakeholder workshops will be held in each state to co-design the approaches to delivering HPV-based screening among 30-49-year-old women. DISCUSSION The quality and outcomes of existing screening services, readiness to transition to HPV-based screening, challenges in providing and participating in the cervical cancer care continuum, and acceptability of screening and treatment approaches will be examined. The knowledge gained about the current system, as well as recognition of actions to be taken, will inform a stakeholder workshop to co-design and evaluate implementation approaches for HPV-based screening through a cluster randomised implementation trial.
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Affiliation(s)
- Anu Mary Oommen
- The University of Melbourne, Melbourne, Australia.
- Christian Medical College, Vellore, Tamil Nadu, India.
| | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
| | | | - Eric Zomawia
- Population Based Cancer Registry, Aizawl, Mizoram, India
| | | | | | - Vidhya Viswanathan
- Directorate of Public Health and Preventive Medicine, Government of Tamil Nadu, Chennai, India
| | | | | | - David Hawkes
- Australian Centre for Prevention of Cervical Cancer, Melbourne, Australia
| | - Marion Saville
- Australian Centre for Prevention of Cervical Cancer, Melbourne, Australia
| | - Julia M L Brotherton
- The University of Melbourne, Melbourne, Australia
- Formerly Australian Centre for Prevention of Cervical Cancer, Melbourne, Australia
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Davies C, Marshall HS, Brotherton JML, McCaffery K, Kang M, Macartney K, Garland S, Kaldor J, Zimet G, Skinner SR. Complex intervention to promote human papillomavirus (HPV) vaccine uptake in school settings: A cluster-randomized trial. Prev Med 2023; 172:107542. [PMID: 37172767 DOI: 10.1016/j.ypmed.2023.107542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/14/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
Using a cluster-randomized trial design, we aimed to evaluate a complex intervention to increase uptake of human papillomavirus (HPV) vaccination in schools. The study was undertaken in high schools in Western Australia and South Australia between 2013 and 2015 with adolescents aged 12-13 years. Interventions included education, shared decision-making, and logistical strategies. The main outcome was school vaccine uptake. Secondary outcomes included consent forms returned and mean time to vaccinate 50 students. We hypothesised that a complex intervention would increase 3-dose HPV vaccine uptake. We recruited 40 schools (21 intervention, 19 control) with 6, 967 adolescents. There was no difference between intervention and control (3-dose mean 75.7% and 78.9%, respectively). Following adjustment for baseline covariates, absolute differences in coverage in favour of the intervention group were: dose 1, 0.8% (95% CI, -1.4,3.0); dose 2, 0.2% (95% CI, -2.7, 3.1); dose 3, 0.5% (95% CI, -2.6, 3.7). The percentage of returned consent forms in intervention schools (91.4%) was higher than in control schools (difference: 6%, 95% CI, 1.4, 10.7). There was a shorter mean time to vaccinate 50 students at dose 3. The difference for dose 3 was 110 min (95% CI, 42, 177); for dose 2, 90 min (95% CI, -15, 196); and dose 1, 28 min (95% CI, -71, 127). Logs revealed the inconsistent implementation of logistical strategies. The intervention had no impact on uptake. Inadequate resourcing for logistical strategies and advisory board reluctance toward strategies with potential financial implications impacted the implementation of logistical components. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry, ACTRN12614000404628, 14.04.2014. The study protocol was published in 2015 before data collection was finalised (Skinner et al., 2015). THE HPV.EDU STUDY GROUP: We would like to acknowledge the contributions to this study by members of the HPV.edu Study Group, including: Professor Annette Braunack-Mayer: Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia; Dr. Joanne Collins: Women's and Children's Health Network and School of Medicine and Robinson Research Institute, University of Adelaide, SA, Australia; Associate Professor Spring Cooper: School of Public Health, City University of New York (CUNY), New York, NY, USA; Heidi Hutton: Telethon Kids Institute, University of Western Australia, WA, Australia; Jane Jones: Telethon Kids Institute, University of Western Australia, WA, Australia; Dr. Adriana Parrella: Women's and Children's Health Network and School of Medicine and Robinson Research Institute, University of Adelaide, SA, Australia; and South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Associate Professor David G. Regan: The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, NSW, Australia; Professor Peter Richmond: Perth Children's Hospital, Child and Adolescent Health Service, Western Australia, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, WA, Australia, and School of Medicine, University of Western Australia, Perth, WA, Australia; Dr. Tanya Stoney: Telethon Kids Institute, University of Western Australia, WA, Australia. Contact for the HPV.edu study group: Cristyn.Davies@sydney.edu.au or Rachel.Skinner@sydney.edu.au.
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Affiliation(s)
- Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Infectious Diseases Institute, The University of Sydney, NSW, Australia; Wellbeing, Health and Youth National Health and Medical Research Council Centre for Research Excellence in Adolescent Health, Sydney, Australia.
| | - Helen S Marshall
- Women's and Children's Hospital and School of Medicine and Robinson Research Institute, The University of Adelaide, SA, Australia
| | - Julia M L Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Victoria, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia; National Centre for Immunisation Research and Surveillance, NSW, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Melissa Kang
- General Practice Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Kristine Macartney
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, NSW, Australia
| | - Suzanne Garland
- Centre Women's Infectious Diseases Research, The Royal Women's Hospital, Melbourne, Victoria, Australia; Reproductive and Neonatal Infectious Diseases, Department of Obstetrics and Gynaecology, University of Melbourne, Murdoch Children's Research Institute, Victoria, Australia
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, NSW, Australia
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University, Indianapolis, USA
| | - S Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Wellbeing, Health and Youth National Health and Medical Research Council Centre for Research Excellence in Adolescent Health, Sydney, Australia
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Kreimer AR, Cernuschi T, Rees H, Brotherton JML, Porras C, Schiller J. Public health opportunities resulting from sufficient HPV vaccine supply and a single-dose vaccination schedule. J Natl Cancer Inst 2023; 115:246-249. [PMID: 36194015 PMCID: PMC9996208 DOI: 10.1093/jnci/djac189] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Many countries with the highest burdens of cervical cancer have not yet offered human papillomavirus (HPV) vaccines to most of their age-eligible girls, who as adults also have limited or no access to effective cervical cancer screening or treatment. There are now 2 complementary developments that could make HPV vaccines more accessible and affordable: 1) the current and projected increases in HPV vaccine supply; and 2) the permissive recommendation for single-dose HPV vaccination schedules. This change in policy paired with the healthier HPV vaccine supply is an incredible opportunity to facilitate rapid access and expansion of HPV vaccination. Female adolescent vaccination including multiage cohorts must be prioritized. In the coming decades, this is the most cost-effective approach to avert millions of projected cervical cancer cases, which account for most HPV-related cancers globally.
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Affiliation(s)
- Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Helen Rees
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas- Fundación INCIENSA (ACIB-FUNIN), San José, Costa Rica
| | - John Schiller
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Bridge F, Brotherton JML, Foong Y, Butzkueven H, Jokubaitis VG, Van der Walt A. Risk of cervical pre-cancer and cancer in women with multiple sclerosis exposed to high efficacy disease modifying therapies. Front Neurol 2023; 14:1119660. [PMID: 36846149 PMCID: PMC9950275 DOI: 10.3389/fneur.2023.1119660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
There is a growing need to better understand the risk of malignancy in the multiple sclerosis (MS) population, particularly given the relatively recent and widespread introduction of immunomodulating disease modifying therapies (DMTs). Multiple sclerosis disproportionately affects women, and the risk of gynecological malignancies, specifically cervical pre-cancer and cancer, are of particular concern. The causal relationship between persistent human papillomavirus (HPV) infection and cervical cancer has been definitively established. To date, there is limited data on the effect of MS DMTs on the risk of persistent HPV infection and subsequent progression to cervical pre-cancer and cancer. This review evaluates the risk of cervical pre-cancer and cancer in women with MS, including the risk conferred by DMTs. We examine additional factors, specific to the MS population, that alter the risk of developing cervical cancer including participation in HPV vaccination and cervical screening programs.
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Affiliation(s)
- Francesca Bridge
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Neurology, Alfred Health, Melbourne, VIC, Australia,*Correspondence: Francesca Bridge ✉
| | - Julia M. L. Brotherton
- Australian Centre for the Prevention of Cervical Cancer (Formerly Victorian Cytology Service), Carlton South, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Yi Foong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Neurology, Alfred Health, Melbourne, VIC, Australia,Department of Neurosciences, Eastern Health, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Vilija G. Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Anneke Van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
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Yeasmeen T, Kelaher M, Brotherton JML. Understanding the types of racism and its effect on mental health among Muslim women in Victoria. Ethn Health 2023; 28:200-216. [PMID: 35067131 DOI: 10.1080/13557858.2022.2027882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Discrimination against racial and ethnic minority groups, especially the Muslim community, is more prevalent in Western countries and anti-Muslim belief, or Islamophobia, is also increasing around the world. Intersectionality of religion, race, and gender makes Muslim women vulnerable to racism. This study investigates different types of racism experienced by Muslim and non-Muslim women living in Victoria, Australia, and the adverse mental health outcome to them after experiencing racism. METHOD Survey data were collected from 580 culturally and linguistically diverse (CALD) Victorian women from four local areas including both rural and urban communities. The survey asked about the participant's racism experience, types of racism, frequency of occurrence, and used the Kessler 6 Psychological Distress Scale to assess psychological distress after experiencing racism. The applied logistic regression analysis to assess the association between types of racism experiences and socio-demographic factors and to examine the impact of racism on individuals' psychological distress. RESULT Muslim women, in general, had higher odds of experiencing racism (OR 1.70, 95% CI 1.02-2.83) than non-Muslim women, including types of racism such as being sworn at or verbally abused or exposed to offensive gestures (OR 1.78, 95% CI 1.11-2.85) and being told that they do not belong in Australia and should go back to their country (OR 1.61, 95% CI 1.00-2.58). Muslim women were more likely to be above the threshold for high or very high psychological distress than non-Muslim women, consistent across most types of racism. CONCLUSION This study has found a higher prevalence of racism experienced by Muslim women compared to other ethnic minority groups and some types of racism are more likely to occur or be more toxic for Muslim women. Necessary intervention strategies should be implemented at every level of the society to raise awareness of and reduce exposure to racism among Muslim women.
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Affiliation(s)
- Tahira Yeasmeen
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Tatar O, Haward B, Zhu P, Griffin-Mathieu G, Perez S, McBride E, Lofters AK, Smith LW, Mayrand MH, Daley EM, Brotherton JML, Zimet GD, Rosberger Z. Understanding the Challenges of HPV-Based Cervical Screening: Development and Validation of HPV Testing and Self-Sampling Attitudes and Beliefs Scales. Curr Oncol 2023; 30:1206-1219. [PMID: 36661742 PMCID: PMC9858121 DOI: 10.3390/curroncol30010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
The disrupted introduction of the HPV-based cervical screening program in several jurisdictions has demonstrated that the attitudes and beliefs of screening-eligible persons are critically implicated in the success of program implementation (including the use of self-sampling). As no up-to-date and validated measures exist measuring attitudes and beliefs towards HPV testing and self-sampling, this study aimed to develop and validate two scales measuring these factors. In October-November 2021, cervical screening-eligible Canadians participated in a web-based survey. In total, 44 items related to HPV testing and 13 items related to HPV self-sampling attitudes and beliefs were included in the survey. For both scales, the optimal number of factors was identified using Exploratory Factor Analysis (EFA) and parallel analysis. Item Response Theory (IRT) was applied within each factor to select items. Confirmatory Factor Analysis (CFA) was used to assess model fit. After data cleaning, 1027 responses were analyzed. The HPV Testing Attitudes and Beliefs Scale (HTABS) had four factors, and twenty-two items were retained after item reduction. The HPV Self-sampling Attitudes and Beliefs Scale (HSABS) had two factors and seven items were retained. CFA showed a good model fit for both final scales. The developed scales will be a valuable resource to examine attitudes and beliefs in anticipation of, and to evaluate, HPV test-based cervical screening.
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Affiliation(s)
- Ovidiu Tatar
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Research Center, Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
| | - Ben Haward
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Patricia Zhu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Samara Perez
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Cedars Cancer Centre, McGill University Health Centre (MUHC), Montreal, QC H4A 3J1, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
| | - Emily McBride
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Aisha K. Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Department of Family and Community Medicine, Women’s College Hospital, Toronto, ON M5S 1B3, Canada
| | | | - Marie-Hélène Mayrand
- Research Center, Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Ellen M. Daley
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Julia M. L. Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VI 3010, Australia
- Population Health, Australian Centre for the Prevention of Cervical Cancer, Melbourne, VI 3053, Australia
| | - Gregory D. Zimet
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
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Zammit CM, Creagh NS, McDermott T, Smith MA, Machalek DA, Jennett CJ, Prang KH, Sultana F, Nightingale CE, Rankin NM, Kelaher M, Brotherton JML. "So, if she wasn't aware of it, then how would everybody else out there be aware of it?"-Key Stakeholder Perspectives on the Initial Implementation of Self-Collection in Australia's Cervical Screening Program: A Qualitative Study. Int J Environ Res Public Health 2022; 19:15776. [PMID: 36497850 PMCID: PMC9739016 DOI: 10.3390/ijerph192315776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In December 2017, the Australian National Cervical Screening Program transitioned from 2-yearly cytology-based to 5-yearly human papillomavirus (HPV)-based cervical screening, including a vaginal self-collection option. Until July 2022, this option was restricted to under- or never-screened people aged 30 years and older who refused a speculum exam. We investigated the perspectives and experiences of stakeholders involved in, or affected by, the initial implementation of the restricted self-collection pathway. METHODS Semi-structured interviews were conducted with 49 stakeholders as part of the STakeholder Opinions of Renewal Implementation and Experiences Study. All interviews were audio recorded and transcribed. Data were thematically analysed and coded to the Conceptual Framework for Implementation Outcomes. RESULTS Stakeholders viewed the introduction of self-collection as an exciting opportunity to provide under-screened people with an alternative to a speculum examination. Adoption in clinical practice, however, was impacted by a lack of clear communication and promotion to providers, and the limited number of laboratories accredited to process self-collected samples. Primary care providers tasked with communicating and offering self-collection described confusion about the availability, participant eligibility, pathology processes, and clinical management processes for self-collection. Regulatory delay in developing an agreed protocol to approve laboratory processing of self-collected swabs, and consequently initially having one laboratory nationally accredited to process samples, led to missed opportunities and misinformation regarding the pathway's availability. CONCLUSIONS Whilst the introduction of self-collection was welcomed, clear communication from Government regarding setbacks in implementation and how to overcome these in practice were needed. As Australia moves to a policy of providing everyone eligible for screening the choice of self-collection, wider promotion to providers and eligible people, clarity around pathology processes and the scaling up of test availability, as well as timely education and communication of clinical management practice guidelines, are needed to ensure smoother program delivery in the future. Other countries implementing self-collection policies can learn from the implementation challenges faced by Australia.
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Affiliation(s)
- Claire M. Zammit
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Nicola S. Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Tracey McDermott
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, VIC 3010, Australia
| | - Megan A. Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2011, Australia
| | - Dorothy A. Machalek
- The Kirby Institute, Wallace Wurth Building, University of New South Wales Kensington, Sydney, NSW 2052, Australia
- Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Melbourne, VIC 3052, Australia
| | - Chloe J. Jennett
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2011, Australia
| | - Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Farhana Sultana
- National Cancer Screening Register, Telstra Health, Melbourne, VIC 3000, Australia
| | - Claire E. Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Nicole M. Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Julia M. L. Brotherton
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, VIC 3010, Australia
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Vujovich-Dunn C, Wand H, Brotherton JML, Gidding H, Sisnowski J, Lorch R, Veitch M, Sheppeard V, Effler P, Skinner SR, Venn A, Davies C, Hocking J, Whop L, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson C, Lane N, Kaldor J, Guy R. Measuring school level attributable risk to support school-based HPV vaccination programs. BMC Public Health 2022; 22:822. [PMID: 35468743 PMCID: PMC9036743 DOI: 10.1186/s12889-022-13088-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/24/2022] [Indexed: 12/27/2022] Open
Abstract
Background In Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation. Methods A population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation (< 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence). Results The factors most strongly associated with lower initiation, and their prevalence were; small schools (OR = 9.3, 95%CI = 6.1–14.1; 33% of schools), special education schools (OR = 5.6,95%CI = 3.7–8.5; 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9–3.7; 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7–3.7; 35% of schools), remote location (OR = 2.6,95%CI = 1.6–4.3; 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3–2.5; 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76–82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31–44) and lower attendance rate (PAR = 37%, 95%CI: 29–46). Conclusion This analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13088-x.
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Affiliation(s)
- C Vujovich-Dunn
- University of New South Wales, Kirby Institute, Kensington, Australia.
| | - H Wand
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - J M L Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Population Health, East Melbourne, Victoria, Australia.,University of Melbourne, Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - H Gidding
- University of Sydney, Northern Clinical School, Sydney, Australia.,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia.,School of Population Health, University of New South Wales, Kensington, Australia.,National Centre for Immunisation Research and Surveillance, Sydney, Australia
| | - J Sisnowski
- University of New South Wales, Kirby Institute, Kensington, Australia.,Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia
| | - R Lorch
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - M Veitch
- Department of Health and Human Services, Tasmanian Government, Hobart, Australia
| | - V Sheppeard
- Communicable Diseases Branch, NSW Health, St Leonards, New South Wales, Australia.,University of Sydney, Sydney School of Public Health, Camperdown, NSW, Australia
| | - P Effler
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia
| | - S R Skinner
- University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, Australia.,Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian, Australia
| | - C Davies
- University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, Australia.,Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - J Hocking
- University of Melbourne, Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - L Whop
- Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia.,Menzies School of Health Research, Charles Darwin University, Cairns, QLD, Australia
| | - J Leask
- National Centre for Immunisation Research and Surveillance, Sydney, Australia.,University of Sydney, Sydney Nursing School, Faculty of Medicine and Health, Camperdown, NSW, Australia
| | - K Canfell
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | - L Sanci
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, VIC, Australia
| | - M Smith
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - M Kang
- University of Sydney, Westmead Clinical School, Sydney, New South Wales, Australia
| | - M Temple-Smith
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, VIC, Australia
| | - M Kidd
- Flinders University, Southgate Institute for Health, Society and Equity, Bedford Park, South Australia, Australia
| | - S Burns
- Curtin University, School of Population Health, Bentley, WA, Australia
| | - L Selvey
- University of Queensland, School of Public Health, St Lucia, QLD, Australia
| | - D Meijer
- Immunisation Unit, Health Protection NSW, St Leonard's, New South Wales, Australia
| | - S Ennis
- Immunisation Unit, Health Protection NSW, St Leonard's, New South Wales, Australia
| | - C Thomson
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia
| | - N Lane
- Department of Health and Human Services, Tasmanian Government, Hobart, Australia
| | - J Kaldor
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - R Guy
- University of New South Wales, Kirby Institute, Kensington, Australia
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10
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Griffin-Mathieu G, Haward B, Tatar O, Zhu P, Perez S, Shapiro GK, McBride E, Thompson EL, Smith LW, Lofters AK, Daley EM, Guichon JR, Waller J, Steben M, Decker KM, Mayrand MH, Brotherton JML, Ogilvie GS, Zimet GD, Norris T, Rosberger Z. Ensuring a successful transition from Pap to HPV-based primary cervical cancer screening in Canada by investigating the psychosocial correlates of women’s intentions: Protocol for an observational study (Preprint). JMIR Res Protoc 2022; 11:e38917. [PMID: 35708742 PMCID: PMC9247817 DOI: 10.2196/38917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 12/18/2022] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
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Affiliation(s)
- Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
| | - Ben Haward
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
- Research Center, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Patricia Zhu
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Samara Perez
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
- Cedars Cancer Center, McGill University Health Centre, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
- HPV Global Action, Montreal, QC, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Emily McBride
- Department of Behavioural Science & Health, University College London, London, United Kingdom
| | - Erika L Thompson
- Department of Biostatistics and Epidemiology, School of Public Health, The University of North Texas Health Science Center, Fort Worth, TX, United States
| | | | - Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Juliet R Guichon
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Marc Steben
- HPV Global Action, Montreal, QC, Canada
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Kathleen M Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Cancer Care Manitoba Research Institute, Winnipeg, MB, Canada
| | - Marie-Helene Mayrand
- Research Center, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
- Département d'obstétrique-gynécologie, Université de Montreal, Montreal, QC, Canada
| | - Julia M L Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Population Health, Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia
| | - Gina S Ogilvie
- BC Cancer Agency, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Women's Hospital, Vancouver, BC, Canada
| | - Gregory D Zimet
- School of Medicine, Indiana University, Bloomington, IN, United States
| | | | - Zeev Rosberger
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
- HPV Global Action, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
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11
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Whop LJ, Butler TL, Lee N, Cunningham J, Garvey G, Anderson K, Condon JR, Tong A, Moore S, Maher CM, Mein JK, Warren EF, Brotherton JML. Aboriginal and Torres Strait Islander women's views of cervical screening by self-collection: a qualitative study. Aust N Z J Public Health 2022; 46:161-169. [PMID: 35112767 DOI: 10.1111/1753-6405.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to describe Aboriginal and Torres Strait Islander women's views of self-collection introduced in the renewed National Cervical Screening Program. METHODS A total of 79 Aboriginal and/or Torres Strait Islander women (50 screened in previous five years, 29 under-screened) from five clinics across three Australian states/territories participated. Topics discussed were perceptions of self-collection, the instruction card and suggestions for implementing self-collection. We employed yarning (a qualitative method), which established relationships and trust between participants and researchers to facilitate culturally safe conversations. Transcripts were analysed thematically. RESULTS Most women were unaware of self-collection before the yarn but found it to be an acceptable way to participate in cervical screening. Women perceived self-collection would be convenient, provide a sense of control over the screening experience, and maintain privacy and comfort. The instructions were perceived to be simple and easy to follow. Women had concerns about collecting the sample correctly and the accuracy of the sample (compared to clinician-collected samples). CONCLUSIONS Self-collection is acceptable to Aboriginal and Torres Strait Islander women. Implications for public health: Given the inequitable burden of cervical cancer experienced by Aboriginal and Torres Strait Islander women, self-collection is likely to significantly improve participation and ultimately improve cervical cancer outcomes.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Australian National University, Australian Capital Territory.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Tamara L Butler
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - Natasha Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - John R Condon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales
| | - Suzanne Moore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Northern Territory
| | - Clare M Maher
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Jacqueline K Mein
- Tropical Public Health Services Cairns, Cairns and Hinterland Hospital Health Service, Queensland Health, Queensland
| | - Eloise F Warren
- Yerin Eleanor Duncan Aboriginal Health Centre, New South Wales
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, Victoria.,Melbourne School of Population and Global Health, University of Melbourne, Victoria
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12
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Davies C, Marshall HS, Zimet G, McCaffery K, Brotherton JML, Kang M, Garland S, Kaldor J, McGeechan K, Skinner SR. Effect of a School-Based Educational Intervention About the Human Papillomavirus Vaccine on Psychosocial Outcomes Among Adolescents: Analysis of Secondary Outcomes of a Cluster Randomized Trial. JAMA Netw Open 2021; 4:e2129057. [PMID: 34726749 PMCID: PMC8564580 DOI: 10.1001/jamanetworkopen.2021.29057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Delivery of vaccination to adolescents via a school-based program provides an opportunity to promote their involvement in health decision-making, service provision, and self-efficacy (belief in one's ability to perform a certain behavior). OBJECTIVE To examine the effect of a human papillomavirus (HPV) vaccination education and logistical intervention on adolescent psychosocial outcomes. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized trial and process and qualitative evaluation, adolescents aged 12 to 13 years (first year of high school) were recruited at high schools in Western Australia (WA) and South Australia (SA) in 2013 and 2014. Statistical analysis was performed from January 2016 to December 2020. INTERVENTIONS The complex intervention consisted of an adolescent intervention to promote knowledge and psychosocial outcomes, shared decisional support tool, and logistical strategies. MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes were assessed. The HPV Adolescent Vaccination Intervention Questionnaire (HAVIQ) was used to measure changes in adolescent knowledge (6-item subscale), fear and anxiety (6-item subscale), self-efficacy (5-item subscale), and decision-making (8-item subscale). The hypothesis was that the intervention would improve adolescent involvement in vaccine decision-making (measured before dose 1 only), improve vaccine-related self-efficacy, and reduce vaccine-related fear and anxiety (measured before doses 1, 2, and 3). Mean (SD) scores for each subscale were compared between intervention and control students. In the process evaluation, focus groups were conducted. Analyses of the HAVIQ data were conducted from 2016 to 2020. Qualitative analyses of the focus groups were undertaken from 2017 to 2020. RESULTS The trial included 40 schools (21 intervention and 19 control) across sectors with 6967 adolescents (mean [SD] age, 13.70 [0.45] years). There were 3805 students (1689 girls and 2116 boys) in the intervention group and 3162 students (1471 girls and 1691 boys) in the control group. The overall response rate for the HAVIQ was 55%. In WA, where parental consent was required, the response rate was 35% (1676 of 4751 students); in SA, where parental consent was not required, it was 97% (2166 of 2216 students). The mean (SD) score for decision-making in the intervention group before dose 1 was 3.50 (0.42) of 5 points and 3.40 (0.40) in the control group, a small but significant difference of 0.11 point (95% CI, 0.06 to 0.16 point; P < .001). There was a small difference in favor of the intervention group in reduced vaccination-related anxiety (pre-dose 1 difference, -0.11 point [95% CI, -0.19 to -0.02 point]; pre-dose 2 difference, -0.18 point [95% CI, -0.26 to -0.10 point]; pre-dose 3 difference, -0.18 [95% CI, -0.24 to -0.11]) and increased vaccination self-efficacy (pre-dose 1 difference, 4.0 points; [95% CI, 1.0 to 7.0 points]; pre-dose 2 difference, 4.0 points [95% CI, 2.0 to 6.0 points]; pre-dose 3 difference, 3.0 points [95% CI, 1.0 to 5.0 points]). Focus group data from 111 adolescents in 6 intervention and 5 control schools revealed more confidence and less anxiety with each vaccine dose. CONCLUSIONS AND RELEVANCE In this cluster randomized trial, there was a small difference in adolescent decisional involvement and vaccine-related confidence and reduced vaccination-related fear and anxiety that was maintained throughout the vaccine course in the intervention vs control groups. Guidelines for vaccination at school should incorporate advice regarding how this outcome can be achieved. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12614000404628.
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Affiliation(s)
- Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Helen S. Marshall
- Women’s and Children’s Hospital and School of Medicine and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia M. L. Brotherton
- VCS Population Health, VCS Foundation, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Kang
- Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Suzanne Garland
- Centre for Women’s Infectious Diseases Research, The Royal Women’s Hospital, Melbourne, Victoria, Australia
- Reproductive and Neonatal Infectious Diseases, Department of Obstetrics and Gynaecology, University of Melbourne, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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13
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Teutsch SM, Nunez CA, Morris A, Eslick GD, Khandaker G, Berkhout A, Novakovic D, Brotherton JML, McGregor S, King J, Egilmezer E, Booy R, Jones CA, Rawlinson W, Thorley BR, Elliott EJ. Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2020. ACTA ACUST UNITED AC 2021; 45. [PMID: 34711146 DOI: 10.33321/cdi.2021.45.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract For 27 years, national prospective data on selected rare childhood diseases have been collected monthly by the Australian Paediatric Surveillance Unit (APSU) from paediatricians and other clinical specialists who report cases in children aged up to 16 years. We report here the annual results of APSU surveillance in 2020 for ten rare communicable diseases and complications of communicable diseases, namely: acute flaccid paralysis (AFP); congenital cytomegalovirus (CMV) infection; neonatal herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection; severe complications of seasonal influenza; juvenile onset recurrent respiratory papillomatosis (JoRRP); congenital rubella syndrome; congenital varicella syndrome; and neonatal varicella infection. We describe the results for each disease in the context of the total period of study, including demographics, clinical characteristics, treatment and short-term outcomes. Despite challenges presented by the coronavirus disease 2019 (COVID-19) pandemic in 2020, more than 1,400 paediatricians reported regularly to the APSU and an overall monthly reporting rate of > 90% was achieved. The minimum AFP target of 1 case per 100,000 children aged less than 15 years was achieved and there were few cases of vaccine-preventable diseases (JoRRP, rubella, varicella). However, high cases of congenital CMV, neonatal HSV and perinatal exposure to HIV persist. There were no severe complications of seasonal influenza reported for the first time in 13 years. This is consistent with other surveillance data reporting a decline of influenza and other communicable diseases in 2020, and likely reflects the wider effects of public health measures to reduce transmission of SARS-CoV-2 in the Australian community.
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Affiliation(s)
- Suzy M Teutsch
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Carlos A Nunez
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Anne Morris
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Guy D Eslick
- The Australian Paediatric Surveillance Unit.,The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
| | - Gulam Khandaker
- Director of Public Health/Public Health Physician and Director of Medical Research, Central Queensland Hospital and Health Service, Rockhampton, Queensland, AUSTRALIA
| | - Angela Berkhout
- Microbiology Registrar, Microbiology and laboratory services, The Royal Children's Hospital, Melbourne, Victoria, AUSTRALIA
| | - Daniel Novakovic
- ENT, Head and Neck Surgeon, Laryngologist, and Director, Dr Liang Voice Program, The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, New South Wales, AUSTRALIA
| | - Julia M L Brotherton
- Medical Director, VCS Population Health, VCS Foundation, Melbourne, Victoria, AUSTRALIA.,Honorary Principal Fellow, Melbourne School of Population and Global Health, University of Melbourne, Victoria, AUSTRALIA
| | - Skye McGregor
- Epidemiologist, The Kirby Institute, UNSW Sydney, New South Wales, AUSTRALIA
| | - Jonathan King
- Epidemiologist, The Kirby Institute, UNSW Sydney, New South Wales, AUSTRALIA
| | - Ece Egilmezer
- Virology Research Laboratory, Prince of Wales Hospital, Randwick, Sydney, New South Wales, AUSTRALIA.,UNSW Sydney, New South Wales, AUSTRALIA
| | - Robert Booy
- Senior Professorial Fellow, National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, AUSTRALIA
| | - Cheryl A Jones
- Dean and Head of Sydney Medical School, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, AUSTRALIA
| | - William Rawlinson
- Senior Medical Virologist, Director of Serology, Virology and OTDS Laboratories, NSW Health Pathology Randwick, Sydney, New South Wales, AUSTRALIA.,UNSW Sydney, New South Wales, AUSTRALIA
| | - Bruce R Thorley
- Head, National Enterovirus Reference Laboratory and WHO Polio Regional Reference Laboratory, Victorian Infectious Disease Reference Laboratory, Melbourne, Victoria, AUSTRALIA.,The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, AUSTRALIA
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, AUSTRALIA.,The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, AUSTRALIA
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14
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Whop LJ, Butler TL, Brotherton JML, Anderson K, Cunningham J, Tong A, Garvey G. Study protocol: Yarning about HPV Vaccination: a qualitative study of factors influencing HPV vaccination among Aboriginal and Torres Strait Islander adolescents in Australia. BMJ Open 2021; 11:e047890. [PMID: 34344679 PMCID: PMC8336189 DOI: 10.1136/bmjopen-2020-047890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander women experience a higher burden of cervical cancer than non-Indigenous women in Australia. Cervical cancer is preventable partly through human papillomavirus (HPV) vaccination; in Australia, this is delivered through the national school-based immunisation programme. While HPV vaccination uptake is high among Australian adolescents, there remain gaps in uptake and completion among Aboriginal and Torres Strait Islander adolescents. This study aims to gain a comprehensive understanding of the barriers and facilitators to HPV vaccination uptake and completion among Aboriginal and Torres Strait Islander adolescents in Queensland, Australia. METHODS AND ANALYSIS The study will be guided by an Indigenist research approach and an ecological model for health promotion. Yarning, a qualitative Indigenous research method, will be conducted in up to 10 schools. Participants will include Year 7 (12/13 years old) Aboriginal and Torres Strait Islander adolescents; parents/caregivers; and local key informants and immunisation programme partners involved in the delivery of school-based HPV immunisation programme. Participants will be recruited through school representatives and investigator networks using purposive and snowball sampling and samples of convenience. Field notes, HPV vaccination clinic observations and sequential diagramming of the HPV vaccination process will be conducted. Thematic analysis of data will be led by Aboriginal and Torres Strait Islander researchers. Synthesised sequential diagrams of the process of HPV vaccination and qualitative themes summarising key findings will be produced. ETHICS AND DISSEMINATION The Aboriginal Health and Medical Research Council of New South Wales Ethics Committee (1646/20), the Australian National University Human Research Ethics Committee (HREC, 2020/478), the HREC of the Northern Territory Department of Health and Menzies School of Health Research (19-3484) and the Townsville Hospital and Health Service HREC (HREC/QTHS/73789) have approved the study. Dissemination will occur via conferences and peer-reviewed publications. Further dissemination will be determined in partnership with the Aboriginal and Torres Strait Islander Steering Committee, including Youth Representatives and Consultation Network.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Tamara L Butler
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Charles Darwin University, Casuarina, Northern Territory, Australia
| | | | - Kate Anderson
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gail Garvey
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Charles Darwin University, Casuarina, Northern Territory, Australia
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15
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Shilling H, Garland SM, Atchison S, Cornall AM, Brotherton JML, Bateson D, McNamee K, Kaldor JM, Hocking JS, Chen MY, Fairley CK, McNulty A, Bell C, Marshall L, Ooi C, Skinner SR, Murray G, Molano M, Tabrizi S, Machalek DA. Human papillomavirus prevalence and risk factors among Australian women 9-12 years after vaccine program introduction. Vaccine 2021; 39:4856-4863. [PMID: 34281743 DOI: 10.1016/j.vaccine.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/08/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Australia, high and widespread uptake of the quadrivalent human papillomavirus (HPV) vaccine has led to substantial population-level reductions in the prevalence of quadrivalent vaccine targeted HPV genotypes 6/11/16/18 in women aged ≤ 35 years. We assessed risk factors for HPV detection among 18-35 year old women, 9-12 years after vaccine program introduction. METHODS Women attending health services between 2015 and 2018 provided a self-collected vaginal specimen for HPV genotyping (Roche Linear Array) and completed a questionnaire. HPV vaccination status was validated against the National Register. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated for factors associated with HPV detection. RESULTS Among 1564 women (median age 24 years; IQR 21-27 years), Register-confirmed ≥ 1-dose vaccine coverage was highest at 69.3% and 68.1% among women aged 18-21 and 22-24 years respectively, decreasing to 42.9% among those aged 30-35 years. Overall prevalence of quadrivalent vaccine-targeted HPV types was very low (2.0%; 95% CI: 1.4-2.8%) and influenced only by vaccination status (5.5% among unvaccinated compared with 0.7% among vaccinated women; aOR = 0.13 (95% CI: 0.05-0.30)). Prevalence of remaining HPV types, at 40.4% (95% CI: 38.0-42.9%), was influenced by established risk factors for HPV infection; younger age-group (p-trend < 0.001), more recent (p < 0.001) and lifetime sexual partners (p-trend < 0.001), but not vaccination status. Prevalence of HPV31/33/45, which shared risk factors with that of non-vaccine targeted HPV types, was also lower among vaccinated (4%) compared with unvaccinated (7%) women (aOR = 0.51; 95% CI: 0.29-0.89), indicative of cross-protection. CONCLUSION Vaccination has changed the epidemiology of HPV infection in Australian women, having markedly reduced the prevalence of vaccine-targeted types, including amongst women with known risk factors for infection. Vaccinated women appear to be benefiting from modest cross-protection against types 31/33/45 afforded by the quadrivalent HPV vaccine. These results reinforce the importance of HPV vaccination.
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Affiliation(s)
- Hannah Shilling
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia; Molecular Microbiology Group, Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia; Molecular Microbiology Group, Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Steph Atchison
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia; Molecular Microbiology Group, Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia
| | - Alyssa M Cornall
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia; Molecular Microbiology Group, Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Julia M L Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia; VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia
| | - Deborah Bateson
- Family Planning New South Wales, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Australia
| | - Kathleen McNamee
- Family Planning Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - John M Kaldor
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, New South Wales, Australia
| | - Charlotte Bell
- Adelaide Sexual Health Clinic, South Australia, Australia
| | - Lewis Marshall
- South Terrace Clinic, Fremantle Hospital, Western Australia, Australia
| | - Catriona Ooi
- Western Sydney Sexual Health Centre, New South Wales, Australia; Northern Sydney Local Health District Sexual Health Service, New South Wales, Australia; Northern Clinical School, Faculty of Health and Medicine, University of Sydney, New South Wales, Australia
| | - S Rachel Skinner
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Australia
| | - Gerald Murray
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia; Molecular Microbiology Group, Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia
| | - Monica Molano
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia; Molecular Microbiology Group, Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sepehr Tabrizi
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia; Molecular Microbiology Group, Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia
| | - Dorothy A Machalek
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia; The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia.
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16
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Palmer M, Katanoda K, Saito E, Martellucci CA, Ostuki S, Nomura S, Ota E, Brotherton JML, Hocking J. National genotype prevalence and age distribution of human papillomavirus from infection to cervical cancer in Japanese women: a systematic review and meta-analysis protocol. Syst Rev 2021; 10:135. [PMID: 33952342 PMCID: PMC8101252 DOI: 10.1186/s13643-021-01686-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite prophylactic human papillomavirus (HPV) vaccination being a safe, effective and cost-effective public health intervention for the prevention of cervical cancer, the HPV vaccine is not actively recommended or promoted by the Ministry of Health Labour and Welfare in Japan. With already very low levels of cervical screening below 30%, and vaccination levels that are below levels that award any population effect at 0.3% of the eligible population, cervical cancer mortality is higher than other similar high-income countries at 4.4/100,000 (2900) deaths per year in 2015. There is limited population-based or nationally representative data for HPV genotype distribution in Japan, thus making an assessment of the burden of vaccine-preventable cervical cancer difficult. Therefore, this systematic review and meta-analysis aims to determine the HPV genotype prevalence and age distribution of HPV infection in women with a cytological or histological diagnosis of normal through cervical cancer in Japan. We anticipate this information will guide and enhance programme interventions to reduce vaccine-preventable cervical cancer mortality in Japan. METHODS PubMed, Embase and the Japan Medical Abstract Society Database will be searched from the date of establishment to March 2021 to identify original research articles that report the prevalence of HPV genotypes in Japanese women with normal cervical cytology, low grade, high grade and cancerous cervical lesions. No exclusion criteria relating to language or publication date will be applied. The quality of the studies will be assessed using the Joanna Briggs checklist for prevalence studies. Randomised control trials, cohort studies, cross-sectional and prevalence studies will be considered eligible. Study findings will be combined using a traditional random-effects or fixed-effects meta-analysis to summarise pooled prevalence and 95% confidence intervals depending on heterogeneity. Subgroup analyses and meta-regression will be used to investigate heterogeneity, and sensitivity analyses will be conducted to assess the robustness of the findings. DISCUSSION To our knowledge, this is the first systematic review protocol that includes both Japanese and English peer-reviewed articles for the determination of genotype-specific HPV prevalence in cytological or histological confirmed normal cervical specimens, low- and high-grade intraepithelial lesions and cervical cancers by age in Japan. We anticipate this information will guide and enhance programme interventions to reduce vaccine-preventable cervical cancer mortality in Japan. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018117596.
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Affiliation(s)
- Matthew Palmer
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan. .,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Kota Katanoda
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Eiko Saito
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Cecilia Acuti Martellucci
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiori Ostuki
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shuhei Nomura
- Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Erika Ota
- St Luke's International University, Global Health Nursing, Tokyo, Japan
| | - Julia M L Brotherton
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,VCS Population Health, VCS Foundation, East Melbourne, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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17
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Jaenke R, Butler TL, Condon J, Garvey G, Brotherton JML, Cunningham J, Anderson K, Tong A, Moore SP, Whop LJ. Health care provider perspectives on cervical screening for Aboriginal and Torres Strait Islander women: a qualitative study. Aust N Z J Public Health 2021; 45:150-157. [PMID: 33683744 DOI: 10.1111/1753-6405.13084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/01/2020] [Accepted: 01/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate perspectives of primary health care providers (HCPs) on providing cervical screening for Aboriginal and Torres Strait Islander women, who experience a higher burden of cervical cancer than other Australian women. METHODS Semi-structured interviews with 13 HCPs from four Australian Indigenous primary health care centres (PHCCs). Transcripts were thematically analysed. RESULTS HCPs discussed the need to approach cervical screening with sensitivity to women's emotional and cultural needs and sustaining relationships built on trust and respect. HCPs reported challenges in promoting screening to Aboriginal and Torres Strait Islander women due to cumbersome systems, competing clinical priorities, workforce capacity limitations and specific challenges associated with implementing the renewed National Cervical Screening Program. CONCLUSIONS In practice, HCPs experience several challenges to delivering cervical screening. Understanding HCPs' perspectives on their approach to cervical screening delivery, and the systems in which this occurs, can help to ensure that they receive adequate support and resources to deliver cervical screening to Aboriginal and Torres Strait Islander women. Implications for public health: It is important that HCPs adopt a multi-faceted, person-centred approach to cervical screening that is responsive to women's needs and that works synchronously with supportive PHCC services and systems and the National Cancer Screening Register.
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Affiliation(s)
- Rachael Jaenke
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Tamara L Butler
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - John Condon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | | | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales
| | - Suzanne P Moore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Lisa J Whop
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,National Centre for Epidemiology and Population Health, Australian National University, Australian Capital Territory
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18
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Brotherton JML, Wheeler C, Clifford GM, Elfström M, Saville M, Kaldor J, Machalek DA. Surveillance systems for monitoring cervical cancer elimination efforts: Focus on HPV infection, cervical dysplasia, cervical screening and treatment. Prev Med 2021; 144:106293. [PMID: 33075352 PMCID: PMC8403014 DOI: 10.1016/j.ypmed.2020.106293] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023]
Abstract
In order to achieve the global elimination of cervical cancer as a public health problem, close surveillance of progress in public health and clinical activities and outcomes across the three pillars of vaccination, screening and treatment will be required. Surveillance should ideally occur within an integrated system that is planned, funded, and regularly evaluated to ensure it is providing timely, accurate and relevant feedback for action. In this paper, we conceptualise the main public health surveillance objectives as process and outcome measures in each of the three pillars. Process measures include coverage/participation measures for vaccination, screening and treatment alongside the ongoing assessment of the quality and reach of these programs and activities. Outcome measures related to the natural history of human papillomavirus (HPV) infection include HPV infection prevalence, precursor cervical lesions and cervical cancers (including stage at diagnosis, cancer incidence and mortality). These outcome measures can be used for monitoring the effectiveness of the three core activities in the short, medium and long term to assess whether these interventions are effectively reducing their occurrence. We discuss possible methods for the surveillance of these measures in the context of country capacity, drawing from examples in Australia, the USA and in low and middle income countries.
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Affiliation(s)
- Julia M L Brotherton
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, Victoria 3002, Australia; Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia.
| | - Cosette Wheeler
- Department of Pathology and Obstetrics & Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Gary M Clifford
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, Cedex 08, France
| | - Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Alfred Nobels Allé 8, 8th floor, 141 52 Huddinge, Stockholm, Sweden
| | - Marion Saville
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, Victoria 3002, Australia; University Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - John Kaldor
- Kirby Institute, Level 6, Wallace Wurth Building, University of New South Wales, High Street, Kensington, NSW 2052, Australia
| | - Dorothy A Machalek
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia; Kirby Institute, Level 6, Wallace Wurth Building, University of New South Wales, High Street, Kensington, NSW 2052, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC 3052, Australia
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19
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Obermair HM, Bennett KF, Brotherton JML, Smith MA, McCaffery KJ, Dodd RH. Australian National Cervical Screening Program renewal: Attitudes and experiences of general practitioners, and obstetricians and gynaecologists. Aust N Z J Obstet Gynaecol 2021; 61:416-423. [PMID: 33512715 DOI: 10.1111/ajo.13310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/13/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND In 2017, the Australian National Cervical Screening Program (NCSP) implemented five-yearly primary human papillomavirus (HPV) screening for women aged 25-74. It is important that clinicians are able to explain the NCSP changes to women and confidently address concerns. AIMS This study examined Australian clinicians' attitudes toward and experiences of the NCSP renewal since its implementation. MATERIALS AND METHODS Cross-sectional survey of clinicians (general practitioners, obstetricians and gynaecologists) involved in cervical screening, distributed two years after implementation of the renewed NCSP. Responses were analysed using descriptive statistics and thematic analysis. RESULTS Six hundred and seven participants completed the survey. More than 80% of clinicians were comfortable with the main NCSP changes: extended screening intervals, increased age of first screening, and screening test used. However, only 47% of clinicians reported having utilised the National Cancer Screening Register, and a third of clinicians did not believe that self-collection was a reasonable alternative to practitioner-collected screening for under-screened women. Increased demands for colposcopy were reported. All clinicians identified at least one area of educational need, including the management of women with a history of screen-detected abnormalities in the previous program (34.9%), post-colposcopy management for women with no abnormalities detected (25.5%), and screening in complex scenarios (eg immunocompromise) (26.5%). CONCLUSIONS Overall, Australian clinicians are comfortable with the main changes to the cervical screening program. Certain areas may require further policy review, such as screening in complex clinical scenarios, colposcopy availability, accessibility of the Register and self-collection. These issues could be meaningful for other countries switching to HPV-based screening.
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Affiliation(s)
- Helena M Obermair
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics & Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kirsty F Bennett
- Department of Behavioural Science and Health, University College London, London, UK
| | - Julia M L Brotherton
- VCS Foundation, Melbourne, Victoria, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Megan A Smith
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Cancer Council NSW, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rachael H Dodd
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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20
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Dodd RH, Nickel B, Smith MA, Brotherton JML, McCaffery KJ. Getting the timing right: Women's views on the best time to announce changes to cancer screening policy recommendations. Prev Med Rep 2020; 20:101268. [PMID: 33318889 PMCID: PMC7724372 DOI: 10.1016/j.pmedr.2020.101268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/04/2020] [Accepted: 11/19/2020] [Indexed: 12/02/2022] Open
Abstract
Women suggest communicating changes to screening programs 6–12 months before implementation. Opportunities to be involved in consultation about changes are important. Preference for information using evidence, with an option of more information. Recognition that the mode of delivery should differ by age.
In December 2017, the Australian National Cervical Screening Program (NCSP) changed from 2-yearly cervical cytology to 5-yearly primary human papillomavirus (HPV) testing, starting at age 25 and with an exit test when aged 70–74. Women showed limited awareness of these changes prior to their implementation. We explored women’s preferences for how similar cancer screening changes could be communicated to the public in the future, including when, how, and using what methods. Six focus groups including 49 women aged 18–74 were conducted in November 2017. Focus groups were guided by information available on the NCSP website and information developed by the researchers. Generally, women suggested that communication of changes to cancer screening programs would ideally occur between 6 and 12 months ahead of their implementation and that they would like the opportunity to be involved in consultation about the changes. The NCSP website was described as answering basic questions, but also raising further questions for which there were no answers provided. Most groups preferred information which included evidence behind the changes and wanted an option of more information. Similar suggestions were made across all focus groups about how communications could be delivered, with recognition that the mode of delivery should differ by age. Women were still seeking information about the test itself and a symptom list, in order to be aware of these over the five-year period. These findings make an important and timely contribution which could help inform other countries considering making changes to their cancer screening programs in the future.
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Affiliation(s)
- Rachael H Dodd
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Brooke Nickel
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Megan A Smith
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia.,Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, VIC 3002, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Kirsten J McCaffery
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
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21
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Smith MA, Hall MT, Saville M, Brotherton JML, Simms KT, Lew JB, Bateson D, Skinner SR, Kelaher M, Canfell K. Could HPV Testing on Self-collected Samples Be Routinely Used in an Organized Cervical Screening Program? A Modeled Analysis. Cancer Epidemiol Biomarkers Prev 2020; 30:268-277. [PMID: 33219163 DOI: 10.1158/1055-9965.epi-20-0998] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/10/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cervical screening on self-collected samples has mainly been considered for targeted use in underscreened women. Updated evidence supports equivalent sensitivity of PCR-based human papillomavirus (HPV) testing on self-collected and clinician-collected samples. METHODS Using a well-established model, we compared the lifetime impact on cancer diagnoses and deaths resulting from cervical screening using self-collected samples only, with and without the existing restriction in Australia to women aged 30+ years and ≥2 years overdue, compared with the mainstream program of 5-yearly HPV screening on clinician-collected samples starting at 25 years of age. We conservatively assumed sensitivity of HPV testing on self-collected relative to clinician-collected samples was 0.98. Outcomes were estimated either in the context of HPV vaccination ("routinely vaccinated cohorts;" uptake as in Australia) or in the absence of HPV vaccination ("unvaccinated cohorts"). RESULTS In unvaccinated cohorts, the health benefits of increased participation from self-collection outweighed the worst case (2%) loss of relative test sensitivity even if only 15% of women, who would not otherwise attend, used it ("additional uptake"). In routinely vaccinated cohorts, population-wide self-collection could be marginally (0.2%-1.0%) less effective at 15% additional uptake but 6.2% to 12.4% more effective at 50% additional uptake. Most (56.6%-65.0%) of the loss in effectiveness in the restricted self-collection pathway in Australia results from the requirement to be 2 or more years overdue. CONCLUSIONS Even under pessimistic assumptions, any potential loss in test sensitivity from self-collection is likely outweighed by improved program effectiveness resulting from feasible levels of increased uptake. IMPACT Consideration could be given to offering self-collection more widely, potentially as an equal choice for women.See related commentary by Lim, p. 245.
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Affiliation(s)
- Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia. .,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michaela T Hall
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Mathematics and Statistics, UNSW, Sydney, New South Wales, Australia
| | - Marion Saville
- VCS Foundation, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate T Simms
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Deborah Bateson
- Family Planning NSW, Sydney, New South Wales, Australia.,Discipline of Obstetrics, Gynaecology & Neonatology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - S Rachel Skinner
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Children's Hospital Westmead, Westmead, New South Wales, Australia
| | - Margaret Kelaher
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia
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22
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Tan JHJ, Jayasinghe YL, Osinski MJ, Brotherton JML, Wrede CDH. Recurrent post-coital bleeding: Should colposcopy still be mandatory? Aust N Z J Obstet Gynaecol 2020; 60:952-958. [PMID: 32914426 DOI: 10.1111/ajo.13247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/11/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Colposcopy has been recommended for all women with recurrent post-coital bleeding (PCB) even if their cervical cytology or co-test (involving oncogenic human papillomavirus (HPV) DNA testing and cytology) are negative. AIMS To determine the risk of cervical cancer and its precursors among women with recurrent PCB with negative cytology or co-test. MATERIALS AND METHODS A retrospective analysis of two cohorts of women with PCB referred to a tertiary colposcopy clinic. Cohort (1) (n = 1846) between 1 January 2000 and 31 December 2016 (cytology-based screening) and Cohort (2) (n = 215) from 1 January 2018 to 31 December 2019 after introduction of primary HPV screening. RESULTS In 1217 (65.9%) women in Cohort (1) referred with negative cytology, there was one cancer (0.08%) and 22 high-grade squamous intraepithelial lesions (HSIL (cervical intraepithelial neoplasia 2/3)) on histopathology. In Cohort (2), there was no cancer or HSIL in 83 women with negative co-tests (negative for oncogenic HPV and cytology). False-negative cytology after a negative referral cytology or co-test was low with 2% of repeat cytology at initial colposcopy showing possible HSIL or worse. CONCLUSIONS Women presenting with PCB and negative cytology alone have a low risk of cancer and could have HPV testing before being triaged to colposcopy. We showed that with the assurance of a negative co-test and the low likelihood of false-negative cytology, these women could avoid colposcopy unless cervical cancer is clinically suspected. There is a need for a larger cohort study to substantiate our findings with more precision.
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Affiliation(s)
- Jeffrey H J Tan
- Oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Yasmin L Jayasinghe
- Oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Margot J Osinski
- Oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | | | - C David H Wrede
- Oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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23
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Cornall AM, Saville M, Pyman J, Callegari ET, Tan FH, Brotherton JML, Malloy MJ, Tabrizi SN, Wrede CD, Garland SM. HPV16/18 prevalence in high-grade cervical lesions in an Australian population offered catch-up HPV vaccination. Vaccine 2020; 38:6304-6311. [PMID: 32736938 DOI: 10.1016/j.vaccine.2020.07.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Using laser capture microdissection (LCM) and sensitive human papillomavirus (HPV) genotyping, we aimed to determine the distribution of vaccine-preventable types in cervical intraepithelial neoplasia grade 3 (CIN3) lesions and adenocarcinoma in situ (AIS) in young women in Victoria, Australia, offered catch-up HPV vaccination, as a baseline for ongoing vaccine impact monitoring. We also compared findings with available pre-vaccination estimates from women with HPV detected on concurrently-collected cytology samples. METHODS Consecutive histologically-confirmed CIN3/AIS biopsies were collected between May 2011 and December 2014 from vaccine-eligible women (born after 30th June 1981). Genotypes present in whole tissue sections (WTS) were determined by a sensitive reverse hybridisation assay; RHA kit HPV SPF10-LiPA25, v1 (Labo Bio-medical Products). Where multiple genotypes were detected, lesions were isolated using LCM and genotyped. Cervical cytology samples from a pre-vaccine cohort had been previously collected and genotyped using HPV Linear Array HPV Genotyping Test (Roche Diagnostics). Mixed-genotype detections in this cohort were resolved to single-lesion-attributable genotypes using hierarchical attribution. RESULTS Overall, 213 and 530 cases were included from pre- and post-vaccine time-periods, respectively. In 18-25 year-olds, the proportion of HPV16/18-positive CIN3/AIS decreased significantly over time from 69% in 2001-2005 (pre-vaccine), to 62% in 2011-2012 (post-vaccine), to 47% in 2013-2014 (p-trend = 0.004). There was no significant change in HPV16/18 in 26-32 year-olds (p-trend = 0.15). In 2013/14, nonavalent vaccine types accounted for 80% of CIN3/AIS in 18-25 year old women and 90% in 26-32 year old women. CONCLUSION Four to 8 years following implementation of HPV vaccination in Australia, approximately 70% of CIN3/AIS in young women was due to HPV16/18. Our data, despite some limitations due to change in methods between pre- and post-vaccine periods, suggests that for vaccine-eligible women aged 18-25 at the time of biopsy, the proportion of HPV16/18-attributable CIN3/AIS lesions is significantly declining post-vaccination.
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Affiliation(s)
- Alyssa M Cornall
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville 3050, Victoria, Australia.
| | - Marion Saville
- VCS Population Health, VCS Foundation, East Melbourne 3002, Victoria, Australia; VCS Pathology, VCS Foundation, Carlton 3053, Victoria, Australia.
| | - Jan Pyman
- Department of Anatomical Pathology, The Royal Women's Hospital, Parkville 3052, Victoria, Australia.
| | - Emma T Callegari
- Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville 3050, Victoria, Australia.
| | - Fiona H Tan
- Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia.
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, East Melbourne 3002, Victoria, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Michael J Malloy
- VCS Population Health, VCS Foundation, East Melbourne 3002, Victoria, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Sepehr N Tabrizi
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville 3050, Victoria, Australia.
| | - C David Wrede
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville 3050, Victoria, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Suzanne M Garland
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville 3050, Victoria, Australia.
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Cornall AM, Brotherton JML, Callegari ET, Tan FH, Saville M, Pyman J, Phillips S, Malloy MJ, Tabrizi SN, Garland SM. Assessment of attribution algorithms for resolving CIN3-related HPV genotype prevalence in mixed-genotype biopsy specimens using laser capture microdissection as the reference standard. Vaccine 2020; 38:6312-6319. [PMID: 32736939 DOI: 10.1016/j.vaccine.2020.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
To make accurate determinations regarding potential and actual impact of HPV vaccine programs, precise estimates of genotype-specific contributions to disease are required for pre- and post-vaccine populations. Definitive determination of lesion-specific genotypes, particularly where multiple genotypes are detected in a sample, can be technically demanding and resource intensive; therefore, most prevalence studies use mathematical algorithms to adjust for multiple genotype detections. There are currently several algorithms, which can produce genotype estimates within a wide range of variability. The use of these for cervical cytology samples has recently been assessed for accuracy against a definitive reference standard, but none have yet been assessed for multiple-genotype-containing whole biopsy specimens. Using laser capture microdissection (LCM) on biopsy samples, lesion-specific genotype prevalence data were generated for a cohort of 516 young Australian women (aged 18-32 years) with cervical intraepithelial neoplasia grade 3 or adenocarcinoma in situ. Using whole tissue section genotype data from the same cohort, including 71 (13.7%) with multiple genotypes, lesion-associated genotype prevalence was estimated using four different attribution algorithms. The proportion of lesions attributable to HPV16 and HPV18 by LCM were 58.4% and 5%, respectively; hierarchical, proportional, single type/minimum and any type/maximum attribution estimates were comparable across genotypes. For analyses utilising whole tissue biopsy cervical specimens, attribution estimates are appropriate for estimating the proportional contribution of individual genotypes to lesions in a population.
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Affiliation(s)
- Alyssa M Cornall
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, East Melbourne 3002, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Emma T Callegari
- Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Parkville 3052, Victoria, Australia
| | - Fiona H Tan
- Department of Surgery, University of Melbourne, The Royal Melbourne Hospital, Parkville 3052, Victoria, Australia.
| | - Marion Saville
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia; VCS Pathology, Carlton, Victoria, Australia.
| | - Jan Pyman
- Department of Anatomical Pathology, Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Samuel Phillips
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia
| | - Michael J Malloy
- VCS Population Health, VCS Foundation, East Melbourne 3002, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville 3052, Victoria, Australia
| | - Sepehr N Tabrizi
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Suzanne M Garland
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia.
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25
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Foster E, Malloy MJ, Jokubaitis VG, Wrede CDH, Butzkueven H, Sasadeusz J, Van Doornum S, Macrae F, Unglik G, Brotherton JML, van der Walt A. Increased risk of cervical dysplasia in females with autoimmune conditions-Results from an Australia database linkage study. PLoS One 2020; 15:e0234813. [PMID: 32555638 PMCID: PMC7302686 DOI: 10.1371/journal.pone.0234813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/02/2020] [Indexed: 12/29/2022] Open
Abstract
Background Autoimmune conditions (AICs) and/or their treatment may alter risk of human papilloma virus (HPV) infection and females with AICs are therefore at an increased risk of cervical dysplasia. However, inclusion of these at-risk populations in cervical cancer screening and HPV-vaccination guidelines, are mostly lacking. This study aimed to determine the prevalence of cervical dysplasia in a wide range of AICs and compare that to HIV and immunocompetent controls to support the optimisation of cervical cancer preventive health measures. Methods Data linkage was used to match cervical screening episodes to emergency department records of females with AICs or HIV to immunocompetent controls over a 14-year period. The primary outcome was histologically confirmed high-grade cervical disease. Results, measured as rates by cytology and histology classification per 1,000 females screened, were analysed per disease group, and intergroup comparisons were performed. Results Females with inflammatory bowel disease (2,683), psoriatic and enteropathic arthropathies (1,848), multiple sclerosis (MS) (1,426), rheumatoid arthritis (1,246), systemic lupus erythematosus and/or mixed connective tissue disease (SLE/MCTD) (702), HIV (44), and 985,383 immunocompetent controls were included. SLE/MCTD and HIV groups had greater rates of high-grade histological and cytological abnormalities compared to controls. Increased rates of low-grade cytological abnormalities were detected in all females with AICs, with the exception of the MS group. Conclusions Females with SLE/MCTD or HIV have increased rates of high-grade cervical abnormalities. The increased low-grade dysplasia rate seen in most females with AICs is consistent with increased HPV infection. These findings support expansion of cervical cancer preventative programs to include these at-risk females.
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Affiliation(s)
- Emma Foster
- Department of Neurology, MS and Neuroimmunology Service, Alfred Health, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Michael J. Malloy
- Victorian Cervical Screening Registry, VCS Population Health, VCS Foundation, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Vilija G. Jokubaitis
- Department of Neurology, MS and Neuroimmunology Service, Alfred Health, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - C. David H. Wrede
- Department of Oncology and Dysplasia, Royal Women’s Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neurology, MS and Neuroimmunology Service, Alfred Health, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Australia
| | - Sharon Van Doornum
- Rheumatology Department, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Finlay Macrae
- Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia
| | - Gary Unglik
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, Australia
| | - Julia M. L. Brotherton
- Victorian Cervical Screening Registry, VCS Population Health, VCS Foundation, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- * E-mail: (AVDW); (JMLB)
| | - Anneke van der Walt
- Department of Neurology, MS and Neuroimmunology Service, Alfred Health, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
- * E-mail: (AVDW); (JMLB)
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26
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Butler TL, Anderson K, Condon JR, Garvey G, Brotherton JML, Cunningham J, Tong A, Moore SP, Maher CM, Mein JK, Warren EF, Whop LJ. Indigenous Australian women's experiences of participation in cervical screening. PLoS One 2020; 15:e0234536. [PMID: 32542004 PMCID: PMC7295213 DOI: 10.1371/journal.pone.0234536] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
Aboriginal and Torres Strait Islander (collectively, Indigenous Australian) women experience a higher burden of cervical cancer than other women. The National Cervical Screening Program (NCSP) is failing to meet the needs of Indigenous Australian women, resulting in many women not regularly participating in cervical screening. However, one third of Indigenous Australian women do participate in cervical screening. The reasons that some women in this population commence and continue to screen remain unheard but could provide insights to support women who currently do not participate. We aimed to describe Indigenous Australian women’s experiences and views of participation in cervical screening by yarning (a culturally-appropriate interview technique) with 50 Indigenous Australian women aged 25–70 years who had completed cervical screening in the past five years, recruited via Primary Health Care Centres (PHCCs) from three jurisdictions. Aboriginal or Torres Strait Islander women researchers conducted the interviews. Thematic analysis identified six themes: screening as a means of staying strong and in control; overcoming fears, shame, and negative experiences of screening; needing to talk openly about screening; the value of trusting relationships with screening providers; logistical barriers; and overcoming privacy concerns for women employed at PHCCs. Despite describing screening as shameful, invasive, and uncomfortable, women perceived it as a way of staying healthy and exerting control over their health. This ultimately supported their participation and a sense of empowerment. Women valued open discussion about screening and strong relationships with health providers. We identified logistical barriers and specific barriers faced by women employed at PHCCs. This study is strengthened by a research approach that centred Indigenous Australian women’s voices. Understanding the experiences of Indigenous Australian women who participate in screening will help screening providers support women to start and continue to screen regularly. Recommendations for practice are provided.
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Affiliation(s)
- Tamara L Butler
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - John R Condon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne P Moore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Clare M Maher
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Brisbane, Queensland, Australia
| | | | - Eloise F Warren
- Yerin Eleanor Duncan Aboriginal Health Centre, Wyong, New South Wales, Australia
| | - Lisa J Whop
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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27
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Brotherton JML, Sundström K. More evidence suggesting that 1-dose human papillomavirus vaccination may be effective. Cancer 2020; 126:1602-1604. [PMID: 32037508 DOI: 10.1002/cncr.32696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/23/2019] [Accepted: 12/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Julia M L Brotherton
- VCS Population Health, VCS Foundation, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
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28
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Dodd RH, Mac O, Brotherton JML, Cvejic E, McCaffery KJ. Levels of anxiety and distress following receipt of positive screening tests in Australia's HPV-based cervical screening programme: a cross-sectional survey. Sex Transm Infect 2020; 96:166-172. [PMID: 32001660 DOI: 10.1136/sextrans-2019-054290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/17/2019] [Accepted: 01/11/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE From December 2017, the Australian National Cervical Screening Program commenced 5 yearly primary human papillomavirus (HPV) screening; one of the first high-income countries to implement primary HPV screening. This study aimed to examine the psychosocial impact of self-reporting testing HPV positive in a sample of women screened since the renewal of the programme. METHODS Women in Australia aged 25-74 years who reported participating in cervical screening since December 2017 were recruited through an online market research company to complete a cross-sectional survey. The primary outcomes were anxiety and general distress. RESULTS 1004 women completed the online survey; 80.9% reported testing HPV negative (HPV-), 6.5% reported testing HPV positive (HPV+) and 12.9% did not know/remember their test result. Women who reported testing HPV+ had significantly poorer psychological outcomes on a range of measures. Those who reported testing HPV+ had higher anxiety scores (53.03 vs 43.58 out of 80, p<0.001), showed more general distress (3.94 vs 2.52 out of 12, p=0.004), concern about their test result (5.02 vs 2.37, p<0.001), expressed greater distress about their test result (7.06 vs 4.74, p<0.001) and cancer worry (quite or very worried 35.4% vs 11.6%, p<0.001) than women who reported testing HPV-. Concern regarding test results was also significantly higher in women who did not know/remember their test result (3.20 vs 2.37, p<0.001) compared with women who reported testing HPV-. Women who reported testing HPV+ had greater knowledge of HPV (9.25 vs 6.62, p<0.001) and HPV testing (2.44 vs 1.30, p<0.001) than women who reported testing HPV-. CONCLUSIONS Receipt of an HPV+ test result was associated with high levels of anxiety and distress, which reached clinical significance. Further work is needed to understand whether distress and concern could be reduced by ensuring all women receive high-quality standardised information with their results or by other interventions.
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Affiliation(s)
- Rachael Helen Dodd
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivia Mac
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia M L Brotherton
- VCS Population Health, Victorian Cytology Service, Carlton South, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Erin Cvejic
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Sultana F, Roeske L, Malloy MJ, McDermott TL, Saville M, Brotherton JML. Implementation of Australia's renewed cervical screening program: Preparedness of general practitioners and nurses. PLoS One 2020; 15:e0228042. [PMID: 31995585 PMCID: PMC6988932 DOI: 10.1371/journal.pone.0228042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022] Open
Abstract
The National Cervical Screening Program (NCSP) in Australia underwent major changes on December 1st, 2017. The program changed from 2-yearly Pap testing for women aged 18–69 years to 5-yearly HPV testing for women aged 25–74 years including differential management pathways for oncogenic HPV 16/18 positive versus HPV non16/18 positive test results and the option of self-collection for under-screened women. We conducted a survey among cervical screening providers in primary care to assess their level of preparedness in undertaking cervical screening before (pre-renewal) and after (post-renewal) the new program was implemented. Surveys were conducted between 14th August and 30th November 2017 (pre-renewal) and 9th February and 26th October 2018 (post-renewal) among cervical screening providers who attended education sessions related to the new guidelines. Preparedness was assessed in three areas: 1) level of comfort implementing the new guidelines (7 questions), 2) level of confidence in their ability to convey information about the new guidelines (9 questions) and 3) level of agreement regarding access to resources to support implementation (11 questions). Proportions were calculated for each question response and pre- and post-renewal periods compared using generalised linear models. Open-ended questions related to anticipated barriers and ways to overcome barriers were also included in the questionnaires. Compared to the pre-renewal period, a higher proportion of practitioners in the post-renewal period were more comfortable offering routine screening to women ≥25 years (p = 0.005) and more confident explaining the rationale for not screening before 25 years (p = 0.015); confident explaining a positive HPV 16/18 (p = 0.04) and HPV non 16/18(p = 0.013) test result and were comfortable with not referring women with a positive HPV non 16/18 test result and low grade/negative cytology for colposcopy (p = 0.01). A higher proportion of Victorian practitioners in the post-renewal period sample were also comfortable (p = 0.04) and confident (p = 0.015) recommending self-collection to under-screened women and agreed that self-collection is a reliable test (p = 0.003). The most commonly reported suggestion was to provide information, education and communication materials to both patients and practitioners. Compared to the pre-renewal period, practitioners in the post-renewal period were better prepared to implement the renewed screening program. Healthcare providers require further support to implement the self-collection pathway.
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Affiliation(s)
- Farhana Sultana
- Formerly VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Lara Roeske
- VCS Pathology, VCS Foundation, Carlton, Victoria, Australia
| | - Michael J. Malloy
- Formerly VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | | | - Marion Saville
- VCS Pathology, VCS Foundation, Carlton, Victoria, Australia
- VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Julia M. L. Brotherton
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia
- * E-mail:
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30
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Tan JHJ, Malloy MJ, Brotherton JML, Saville M. Compliance with follow-up Test of Cure and outcomes after treatment for high-grade cervical intraepithelial neoplasia in Victoria, Australia. Aust N Z J Obstet Gynaecol 2020; 60:433-437. [PMID: 31950488 DOI: 10.1111/ajo.13115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/10/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Test of Cure (ToC), a combination of testing for oncogenic human papillomavirus (HPV) and cytology, at 12 months post-treatment and annually thereafter, was approved in Australia in 2005 for follow-up of women treated for high-grade squamous intraepithelial lesions (HSIL) of the cervix. AIMS To determine among women resident in Victoria, Australia, the compliance with ToC and the incidence of recurrence up to five years after successful ToC. MATERIALS AND METHODS A retrospective analysis of women with HSIL (diagnosed at pre-treatment punch biopsy or at excision) who had excisional treatment between 1 January 2007 and 31 December 2011. De-identified data were retrieved from the Victorian Cervical Cytology Registry in Melbourne as at 24 April, 2015. Successful ToC is defined as the occurrence of two consecutive normal (negative) co-tests. Recurrence after treatment is defined by histologically detected HSIL or greater. RESULTS There were 8478 women who had excisional treatment for HSIL, with 448 (5.5%) experiencing recurrence. Only 2253 (26.6%) women successfully completed ToC, with a decreasing likelihood of ToC completion by time since year of treatment (32.0% in 2007 compared with 20.9% in 2011). Only one (0.08%) woman had HSIL on histology after successful ToC. From the 2007 cohort, 555 (32.0%) women completed ToC successfully and no HSIL recurrence occurred thereafter (median subsequent follow-up period of 4.7 years). CONCLUSIONS Our study confirmed that women who successfully complete ToC can be returned to five-year routine screening. However, more concerted efforts are needed to ensure that all women treated complete ToC.
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Affiliation(s)
- Jeffrey H J Tan
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Malloy
- VCS Population Health, VCS Foundation, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Marion Saville
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,VCS Foundation, Melbourne, Victoria, Australia
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Subasinghe AK, Wark JD, Phillips S, Cornall A, Brotherton JML, Garland SM. Quadrivalent human papillomavirus vaccination successfully reduces the prevalence of vaccine-targeted genotypes in a young, vaccine-eligible-age sample of Australian females. Sex Health 2020; 17:510-516. [PMID: 33341122 DOI: 10.1071/sh20033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022]
Abstract
Background The prevalence of genital tract vaccine-type human papillomavirus (HPV) is on the decline due to high vaccine uptake through the national HPV immunisation program in Australia. The aim of this study was to investigate HPV vaccine coverage and factors associated with HPV in a vaccine-eligible sample of young Australian females. METHODS Females aged 16-25 years were recruited into the Young Female Health Initiative study, a young women's health study, via Facebook advertising from 2012 to 2017. Sexually active participants were asked to provide a self-collected vaginal swab for the detection of HPV DNA; positive samples were genotyped. Self-reported HPV vaccination status was confirmed by the National HPV Vaccination Program Register. Outcomes of the study were HPV acquisition and genotype, HPV vaccination status and factors associated with HPV. RESULTS Overall, 22.8% of samples (95% confidence interval (CI) 17.8-27.8%; n = 62/272) were positive for any HPV DNA, of which 19.1% (95% CI 14.4-23.8%; n = 52/272) were oncogenic types. HPV 16 was detected in three samples (1.1%; 95% CI -0.1%, 2.3%; two not HPV vaccinated and one vaccinated after sexual debut). Early sexual debut (<16 years) and multiple sexual partners were independently associated with an increased risk of any HPV. CONCLUSIONS In a community sample of vaccine-eligible-age females with a high vaccine uptake, the prevalence of vaccine-related HPV genotypes is extremely low. Early sexual debut and multiple sexual partners are positively associated with HPV, underscoring the importance of vaccination at the routinely recommended age of 12-13 years for best vaccine impact.
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Affiliation(s)
- Asvini K Subasinghe
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Present address: Department of General Practice, Monash University, 1/270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia; and Corresponding author.
| | - John D Wark
- The University of Melbourne Department of Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia; and Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia
| | - Samuel Phillips
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia
| | - Alyssa Cornall
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, East Melbourne, Vic. 3002, Australia; and Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3053, Australia
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia
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32
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Machalek DA, Garland SM, Brotherton JML, Bateson D, McNamee K, Stewart M, Rachel Skinner S, Liu B, Cornall AM, Kaldor JM, Tabrizi SN. Very Low Prevalence of Vaccine Human Papillomavirus Types Among 18- to 35-Year Old Australian Women 9 Years Following Implementation of Vaccination. J Infect Dis 2019; 217:1590-1600. [PMID: 29425358 DOI: 10.1093/infdis/jiy075] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/06/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction A quadrivalent human papillomavirus vaccination program targeting females aged 12-13 years commenced in Australia in 2007, with catch-up vaccination of 14-26 year olds through 2009. We evaluated the program's impact on HPV prevalence among women aged 18-35 in 2015. Methods HPV prevalence among women aged 18-24 and 25-35 was compared with prevalence in these age groups in 2005-2007. For women aged 18-24, we also compared prevalence with that in a postvaccine study conducted in 2010-2012. Results For the 2015 sample, Vaccination Register-confirmed 3-dose coverage was 53.3% (65.0% and 40.3% aged 18-24 and 25-35, respectively). Prevalence of vaccine HPV types decreased from 22.7% (2005-2007) and 7.3% (2010-2012), to 1.5% (2015) (P trend < .001) among women aged 18-24, and from 11.8% (2005-2007) to 1.1% (2015) (P = .001) among those aged 25-35. Conclusions This study, reporting the longest surveillance follow-up to date, shows prevalence of vaccine-targeted HPV types has continued to decline among young women. A substantial fall also occurred in women aged 25-35, despite lower coverage. Strong herd protection and effectiveness of less than 3 vaccine doses likely contributed to these reductions.
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Affiliation(s)
- Dorothy A Machalek
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,School of Population and Global Health, University of Melbourne, Victoria
| | - Suzanne M Garland
- Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
| | - Julia M L Brotherton
- School of Population and Global Health, University of Melbourne, Victoria.,National HPV Vaccination Program Register, Victorian Cytology Service, East Melbourne, Victoria
| | - Deborah Bateson
- Family Planning New South Wales, Sydney.,Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney
| | - Kathleen McNamee
- Family Planning Victoria, Melbourne.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria
| | | | - S Rachel Skinner
- Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead
| | - Bette Liu
- School of Public Health and Community Medicine
| | - Alyssa M Cornall
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
| | - John M Kaldor
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
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Velentzis LS, Brotherton JML, Canfell K. Recurrent disease after treatment for cervical pre-cancer: determining whether prophylactic HPV vaccination could play a role in prevention of secondary lesions. Climacteric 2019; 22:596-602. [PMID: 31030590 DOI: 10.1080/13697137.2019.1600500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Existing modalities can effectively treat high-grade cervical intraepithelial neoplasia (CIN) but around 7% of treated women will develop recurrence of CIN grade 2 or above within 2 years of treatment. Post-treatment surveillance is therefore required to detect residual or recurrent disease. Since the implementation of human papillomavirus (HPV) vaccination programs in high-income countries, significant reductions in high-grade CIN have been recorded in vaccinated cohorts who were predominantly HPV-naïve at vaccination. There is still debate as to the extent of potential benefit from vaccination for women previously infected with HPV, given that HPV incidence in women falls with age and previously cleared infection provides at least some protection against reinfection. Whilst vaccination-induced antibodies could prevent type-specific new infections, it is unclear whether vaccination could also prevent reactivation of latent, previously acquired infection and subsequent disease. A review of the available evidence suggests a potential reduction in risk of recurrent disease if women diagnosed and treated for CIN are offered prophylactic vaccines. New modeled analyses and, ideally, a prospectively designed randomized controlled trial in women treated and then randomized to vaccination or placebo would provide much-needed additional evidence to support the effectiveness and cost-effectiveness of offering vaccination to women after treatment for CIN.
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Affiliation(s)
- L S Velentzis
- Cancer Research Division, Cancer Council NSW , Sydney , NSW , Australia.,Melbourne School of Population and Global Health, University of Melbourne , Melbourne , VIC , Australia
| | - J M L Brotherton
- Melbourne School of Population and Global Health, University of Melbourne , Melbourne , VIC , Australia.,VCS Population Health, VCS Foundation , Carlton , VIC , Australia
| | - K Canfell
- Cancer Research Division, Cancer Council NSW , Sydney , NSW , Australia.,School of Public Health, University of Sydney , Sydney , NSW , Australia.,Prince of Wales Clinical School, University of New South Wales , Sydney , NSW , Australia
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Novakovic D, Cheng ATL, Zurynski Y, Booy R, Walker PJ, Berkowitz R, Harrison H, Black R, Perry C, Vijayasekaran S, Wabnitz D, Burns H, Tabrizi SN, Garland SM, Elliott E, Brotherton JML. A Prospective Study of the Incidence of Juvenile-Onset Recurrent Respiratory Papillomatosis After Implementation of a National HPV Vaccination Program. J Infect Dis 2019; 217:208-212. [PMID: 29136168 DOI: 10.1093/infdis/jix498] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Recurrent respiratory papillomatosis is a rare but morbid disease caused by human papillomavirus (HPV) types 6 and 11. Infection is preventable through HPV vaccination. Following an extensive quadrivalent HPV vaccination program (females 12-26 years in 2007-2009) in Australia, we established a method to monitor incidence and demographics of juvenile-onset recurrent respiratory papillomatosis (JORRP) cases. Methods The Australian Paediatric Surveillance Unit undertakes surveillance of rare pediatric diseases by contacting practitioners monthly. We enrolled pediatric otorhinolaryngologists and offered HPV typing. We report findings for 5 years to end 2016. Results The average annual incidence rate was 0.07 per 100000. The largest number of cases was reported in the first year, with decreasing annual frequency thereafter. Rates declined from 0.16 per 100000 in 2012 to 0.02 per 100000 in 2016 (P = .034). Among the 15 incident cases (60% male), no mothers were vaccinated prepregnancy, 20% had maternal history of genital warts, and 60% were first born; 13/15 were born vaginally. Genotyped cases were HPV-6 (n = 4) or HPV-11 (n = 3). Conclusion To our knowledge, this is the first report internationally documenting decline in JORRP incidence in children following a quadrivalent HPV vaccination program.
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Affiliation(s)
- Daniel Novakovic
- University of Sydney Medical School, University of Sydney and Kids Research Institute, Sydney Children's Hospitals Network (Westmead)
| | - Alan T L Cheng
- University of Sydney Medical School, University of Sydney and Kids Research Institute, Sydney Children's Hospitals Network (Westmead).,ENT Department, Children's Hospital Westmead, University of Sydney and Kids Research Institute, Sydney Children's Hospitals Network (Westmead)
| | - Yvonne Zurynski
- University of Sydney Medical School, University of Sydney and Kids Research Institute, Sydney Children's Hospitals Network (Westmead).,Australian Paediatric Surveillance Unit, University of Sydney and Kids Research Institute, Sydney Children's Hospitals Network (Westmead)
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, Children's Hospital Westmead
| | - Paul J Walker
- Otolaryngology Department, John Hunter Children's Hospital, Newcastle, New South Wales
| | - Robert Berkowitz
- Otolaryngology Department, Royal Children's Hospital, Melbourne, Victoria
| | - Henley Harrison
- ENT Department, Sydney Children's Hospital, Randwick, New South Wales
| | - Robert Black
- Paediatric Otolaryngology Head and Neck Surgery Department, Lady Cilento Children's Hospital, Brisbane, Queensland
| | - Christopher Perry
- Paediatric Otolaryngology Head and Neck Surgery Department, Lady Cilento Children's Hospital, Brisbane, Queensland
| | - Shyan Vijayasekaran
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Hospital for Children, Perth, Western Australia
| | - David Wabnitz
- Department of Otolaryngology - Head and Neck Surgery, Women's and Children's Hospital, Adelaide, South Australia
| | - Hannah Burns
- Paediatric Otolaryngology Head and Neck Surgery Department, Lady Cilento Children's Hospital, Brisbane, Queensland
| | - Sepehr N Tabrizi
- Royal Women's Hospital, Department of Microbiology and Infectious Diseases, and Murdoch Children's Research Institute, Infection and Immunity Theme, Parkville.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville
| | - Suzanne M Garland
- Royal Women's Hospital, Department of Microbiology and Infectious Diseases, and Murdoch Children's Research Institute, Infection and Immunity Theme, Parkville.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville
| | - Elizabeth Elliott
- Australian Paediatric Surveillance Unit, University of Sydney and Kids Research Institute, Sydney Children's Hospitals Network (Westmead)
| | - Julia M L Brotherton
- National HPV Vaccination Program Register, VCS, East Melbourne.,School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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Brotherton JML. The remarkable impact of bivalent HPV vaccine in Scotland. BMJ 2019; 365:l1375. [PMID: 30944088 DOI: 10.1136/bmj.l1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hall MT, Smith MA, Brotherton JML, Simms KT, Canfell K. Cancer elimination thresholds: one size does not fit all - Authors' reply. Lancet Public Health 2019; 4:e87. [PMID: 30738508 DOI: 10.1016/s2468-2667(18)30258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/26/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Michaela T Hall
- Cancer Research Division, Cancer Council NSW, Sydney, NSW 2011, Australia; School of Mathematics and Statistics, University of New South Wales, Sydney, NSW, Australia.
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, NSW 2011, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | | | - Kate T Simms
- Cancer Research Division, Cancer Council NSW, Sydney, NSW 2011, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW 2011, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
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Smith MA, Brotherton JML, Hammond IG, Anderson L, Simms KT, Saville M, Canfell K. Inaccurate and fundamentally flawed analysis risks undermining confidence in cervical screening programs. J Am Soc Cytopathol 2018; 7:336-338. [PMID: 31043305 DOI: 10.1016/j.jasc.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ian G Hammond
- Division of Obstetrics and Gynaecology, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia; School of Human Sciences, Faculty of Science, University of Western Australia, Perth, Australia
| | - Lyndal Anderson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Australia; NSW Health Pathology, Sydney Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kate T Simms
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Marion Saville
- VCS Pathology, VCS Foundation, Melbourne, Australia; Department of Obstetrics and Gynaecology, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Staples C, Butler M, Nguyen J, Durrheim DN, Cashman P, Brotherton JML. Opportunities to increase rates of human papillomavirus vaccination in the New South Wales school program through enhanced catch-up. Sex Health 2018; 13:536-539. [PMID: 27568237 DOI: 10.1071/sh15132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 07/04/2016] [Indexed: 11/23/2022]
Abstract
Background The National Human Papillomavirus (HPV) Vaccination Program provides HPV vaccine to high school students through school-based vaccination. We aimed to: 1) assess the vaccine completion rates achieved when general practice is used for completing doses missed at school; 2) estimate the extent of under-notification by general practices of vaccine doses administered; and 3) assess the reasons reported by parents of students for non-completion of HPV vaccination. METHODS A postal survey was conducted of parents and carers of students and identified, using school-program records, as incompletely vaccinated in a large regional area of northern NSW vaccinated during 2010. Information about additional HPV vaccine doses received or reasons for non-completion were sought. Responses were analysed and records cross-checked against the National HPV Vaccination Program Register. RESULTS Of 660 parents or carers contacted, 207 (31.4%) responded. We found: 1) completion rates increased, an additional 122/207 (45.2%) students had completed all three doses of HPV through their general practitioner (GP); 2) under-notification of GP doses to the National HPV Vaccination Program Register was an issue with only 5/165 (3.0%) reported; 3) the main reason for non-completion was being unaware of the opportunity to catch-up at a GP. CONCLUSIONS Underreporting by GPs of HPV vaccine doses administered and failure to complete courses identifies two opportunities to increase HPV vaccine coverage. These could be addressed by extending provision of catch-up HPV doses in school and by developing practice software solutions for automatic notification of doses from GPs. Reasons given by parents for non-completion, mostly logistical barriers, indicate a high degree of acceptance of HPV vaccination.
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Affiliation(s)
- Christine Staples
- Hunter New England Local Health District, Booth Building, Longworth Avenue, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Michelle Butler
- Hunter New England Local Health District, Booth Building, Longworth Avenue, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Jennifer Nguyen
- National Human Papillomavirus Vaccination Program Register, Victorian Cytology Service, PO Box 310, East Melbourne, Vic. 8002, Australia
| | - David N Durrheim
- Hunter New England Local Health District, Booth Building, Longworth Avenue, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Patrick Cashman
- Hunter New England Local Health District, Booth Building, Longworth Avenue, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Julia M L Brotherton
- National Human Papillomavirus Vaccination Program Register, Victorian Cytology Service, PO Box 310, East Melbourne, Vic. 8002, Australia
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Toliman PJ, Kaldor JM, Badman SG, Phillips S, Tan G, Brotherton JML, Saville M, Vallely AJ, Tabrizi SN. Evaluation of self-collected vaginal specimens for the detection of high-risk human papillomavirus infection and the prediction of high-grade cervical intraepithelial lesions in a high-burden, low-resource setting. Clin Microbiol Infect 2018; 25:496-503. [PMID: 29906593 DOI: 10.1016/j.cmi.2018.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 05/08/2018] [Accepted: 05/12/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the performance of self-collected vaginal (V) specimens with clinician-collected cervical (C) specimens for detection of high-risk human papillomavirus (hrHPV) and cervical disease using the Cepheid Xpert HPV, Roche Cobas 4800 HPV and Hologic Aptima HPV assays. METHODS Women aged 30-59 years (n = 1005) were recruited at two clinics in Papua New Guinea, and they provided specimens for testing at point-of-care using the Xpert HPV Test, and for subsequent testing using the Cobas HPV (n = 981) and Aptima HPV (n = 983) assays. Liquid-based cytology was performed on C specimens to predict underlying high-grade squamous intraepithelial lesions (HSIL). V specimen results of each assay were evaluated against a constructed reference standard and for detection of HSIL or worse. RESULTS There was substantial (κ >0.6) agreement in hrHPV detection between V and C specimens across all three assays. The sensitivity, specificity, and positive and negative predictive values of Xpert HPV using self-collected V specimens for the detection of HPV type 16 according to the constructed reference standard were 92.1%, 93.1%, 63.6% and 98.9%, respectively; compared with 90.4%, 94.3%, 67.8% and 98.7% for Cobas 4800 HPV; and 63.2%, 97.2%, 75.0% and 95.3% for Aptima HPV. Similar results were observed for all hrHPV types (combined) and for HPV types 18/45, on all three assays. The detection of any hrHPV using self-collected specimens had high sensitivity (86%-92%), specificity (87%-94%) and negative predictive value (>98%) on all assays for HSIL positivity. CONCLUSIONS Xpert HPV, using self-collected vaginal specimens, has sufficient accuracy for use in point-of-care 'test-and-treat' cervical screening strategies in high-burden, low-resource settings.
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Affiliation(s)
- P J Toliman
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - J M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - S G Badman
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - S Phillips
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Vic., Australia; Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - G Tan
- Victorian Cytology Service, Melbourne, Vic., Australia
| | | | - M Saville
- Victorian Cytology Service, Melbourne, Vic., Australia
| | - A J Vallely
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - S N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Vic., Australia; Murdoch Children's Research Institute, Parkville, Vic., Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Vic., Australia
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40
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Pillsbury AJ, Quinn HE, Evans TD, McIntyre PB, Brotherton JML. Population-Level Herd Protection of Males From a Female Human Papillomavirus Vaccination Program: Evidence from Australian Serosurveillance. Clin Infect Dis 2018; 65:827-832. [PMID: 29017279 DOI: 10.1093/cid/cix436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/07/2017] [Indexed: 12/24/2022] Open
Abstract
Background Australia instituted funded female human papillomavirus (HPV) immunization in 2007, followed by a targeted male vaccination program in 2013. To date, Australia is one of only several countries with a funded male HPV immunization program. In 2012-2013, we conducted a survey of HPV seroprevalence in males to assess whether or not a herd impact of female vaccination could be observed. Methods We conducted a cross-sectional study of de-identified residual diagnostic test serum samples from males aged 15-39 years from laboratories in 3 Australian states and calculated the proportion seropositive to HPV types 6, 11, 16, and 18. We compared type-specific results by age group against those from a baseline 2005 Australian HPV serosurvey. Results There were decreases in proportion seropositive for every HPV type across all age groups, many statistically significant. The largest decrease was observed for HPV-11, with decreases of 8- and 9-fold for ages 20-29 and 30-39 years, respectively. Despite substantial reductions in seroprevalence, at least 9% of males were seropositive for at least 1 of the 4 HPV types. Conclusions This is the first serosurvey confirming broad population-level impact in males from female HPV vaccination. Our research may assist policy makers considering implementing HPV vaccination programs.
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Affiliation(s)
| | - Helen E Quinn
- National Centre for Immunisation Research and Surveillance, Westmead.,Discipline of Paediatrics and Child Health, University of Sydney, New South Wales, Australia
| | | | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead.,Discipline of Paediatrics and Child Health, University of Sydney, New South Wales, Australia
| | - Julia M L Brotherton
- National HPV Vaccination Program Register, Victorian Cytology Service, East Melbourne.,School of Population and Global Health, University of Melbourne, Victoria, Australia
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Diaz A, Baade PD, Valery PC, Whop LJ, Moore SP, Cunningham J, Garvey G, Brotherton JML, O’Connell DL, Canfell K, Sarfati D, Roder D, Buckley E, Condon JR. Comorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012). PLoS One 2018; 13:e0196764. [PMID: 29738533 PMCID: PMC5940188 DOI: 10.1371/journal.pone.0196764] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Little is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous women's higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women. METHODS Data for cervical cancers diagnosed in 2003-2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women. RESULTS Of 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score ≥1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evident among those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9-3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality. CONCLUSIONS Survival was lowest for women with comorbidity. However, there wasn't a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted. IMPACT The results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity).
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Affiliation(s)
- Abbey Diaz
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Peter D. Baade
- Cancer Council Queensland, Spring Hill, Queensland, Australia
| | - Patricia C. Valery
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - Lisa J. Whop
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Suzanne P. Moore
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Julia M. L. Brotherton
- Victorian Cytology Service, Carlton, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dianne L. O’Connell
- Cancer Council NSW, Cancer Research Division, Kings Cross, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Karen Canfell
- Cancer Council NSW, Cancer Research Division, Kings Cross, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of NSW, Sydney, New South Wales, Australia
| | | | - David Roder
- Cancer Epidemiology & Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth Buckley
- Cancer Epidemiology & Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - John R. Condon
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
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Affiliation(s)
- Daniel Novakovic
- University of Sydney Medical School, University of Sydney, Sydney
| | - Julia M L Brotherton
- National HPV Vaccination Program Register, VCS, East Melbourne.,School of Population and Global Health, University of Melbourne, Parkville, Australia
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Mesher D, Soldan K, Lehtinen M, Beddows S, Brisson M, Brotherton JML, Chow EPF, Cummings T, Drolet M, Fairley CK, Garland SM, Kahn JA, Kavanagh K, Markowitz L, Pollock KG, Söderlund-Strand A, Sonnenberg P, Tabrizi SN, Tanton C, Unger E, Thomas SL. Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes. Emerg Infect Dis 2018; 22:1732-40. [PMID: 27648688 PMCID: PMC5038419 DOI: 10.3201/eid2210.160675] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20-24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations; consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important.
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Drolet M, Laprise JF, Brotherton JML, Donovan B, Fairley CK, Ali H, Bénard É, Martin D, Brisson M. The Impact of Human Papillomavirus Catch-Up Vaccination in Australia: Implications for Introduction of Multiple Age Cohort Vaccination and Postvaccination Data Interpretation. J Infect Dis 2017; 216:1205-1209. [PMID: 28968800 DOI: 10.1093/infdis/jix476] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/08/2017] [Indexed: 11/14/2022] Open
Abstract
We used transmission-dynamic modeling to estimate the added effectiveness of vaccinating multiple cohorts of females (12-26 years) in Australia compared with the theoretical introduction of routine-only (12-13 years) vaccination. Our results suggest that vaccinating multiple cohorts produced markedly faster direct/herd effects, and it added benefits that last for 20-70 years. Furthermore, the number needed to vaccinate to prevent 1 anogential warts (AGW) case or cervical cancer (CC) was similar for routine + catch-up (AGW = 9.9, CC = 678) and routine-only vaccination (AGW = 9.9, CC = 677), thus providing similar levels of efficiency per person vaccinated.
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Affiliation(s)
- Mélanie Drolet
- Centre de Recherche du CHU de Québec-Université Laval, Canada
| | | | - Julia M L Brotherton
- National HPV Vaccination Program Register, Victorian Cytology Service, Melbourne, Australia.,School of Population and Global Health, University of Melbourne, Victoria, Australia
| | | | - Christopher K Fairley
- Melbourne Sexual Health Centre and Central Clinical School Monash University, Melbourne, Australia
| | - Hammad Ali
- The Kirby Institute, UNSW Sydney, Australia
| | - Élodie Bénard
- Centre de Recherche du CHU de Québec-Université Laval, Canada
| | - Dave Martin
- Centre de Recherche du CHU de Québec-Université Laval, Canada
| | - Marc Brisson
- Centre de Recherche du CHU de Québec-Université Laval, Canada.,Université Laval, Québec, Canada.,Imperial College, London, United Kingdom
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Garland SM, Brotherton JML, Moscicki AB, Kaufmann AM, Stanley M, Bhatla N, Sankaranarayanan R, de Sanjosé S, Palefsky JM. HPV vaccination of immunocompromised hosts. Papillomavirus Res 2017; 4:35-38. [PMID: 29179867 PMCID: PMC5883202 DOI: 10.1016/j.pvr.2017.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 01/04/2023]
Abstract
It is well-established that immunocompromised people are at increased risk of HPV-related disease compared with those who are immunocompetent. Prophylactic HPV sub-unit vaccines are safe and immunogenic in immunocompromised people and it is strongly recommended that vaccination occur according to national guidelines. When delivered to immunocompromised populations, HPV vaccines should be given as a 3-dose regimen.
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Affiliation(s)
- S M Garland
- Department of Microbiology and Infectious Diseases, Royal Women's Hospital, 30 Flemington Road, Parkville 3052, Australia; Murdoch Childrens Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Australia.
| | - J M L Brotherton
- VCS Registries, Victorian Cytology Service, Level 6, 176 Wellington Parade, East Melbourne 3002, Australia; School of Population and Global Health, University of Melbourne, Parkville 3052, Australia.
| | - A B Moscicki
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave. MDCC 22-432, MC:175217, Los Angeles, CA 90095, United States.
| | - A M Kaufmann
- Gynäkologische Tumorimmunologie, R. 4503 Gynäkologie, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
| | - M Stanley
- Department of Pathology, Tennis Court Road, Cambridge CB2 1QP, United Kingdom.
| | - N Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - R Sankaranarayanan
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France.
| | - S de Sanjosé
- Cancer Epidemiology Research Programme, IDIBELL, CIBERESP, Institut Català d'Oncologia, Av. Gran Via de l'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Spain.
| | - J M Palefsky
- University of California, San Francisco, 513 Parnassus Ave Box 0654, San Francisco, CA 94143, United States.
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Brotherton JML. Confirming cross-protection of bivalent HPV vaccine. The Lancet Infectious Diseases 2017; 17:1227-1228. [DOI: 10.1016/s1473-3099(17)30539-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 10/18/2022]
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Chow EPF, Wigan R, McNulty A, Bell C, Johnson M, Marshall L, Regan DG, Owen L, Brotherton JML, Bradshaw CS, Fairley CK, Russell D, Chen MY. Early sexual experiences of teenage heterosexual males in Australia: a cross-sectional survey. BMJ Open 2017; 7:e016779. [PMID: 29038178 PMCID: PMC5652582 DOI: 10.1136/bmjopen-2017-016779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE There are limited data on the patterns of early sexual behaviours among Australian teenage heterosexual boys. This study describes the nature and onset of early sexual experiences in this population through a cross-sectional survey. DESIGN A cross-sectional survey between 2014 and 2015 SETTING: Major sexual health clinics and community sources across Australia PARTICIPANTS: Heterosexual men aged 17-19 years RESULTS: There were 191 men in the study with a median age of 19.1 years. Median age at first oral sex was 16.4 years (IQR: 15.5-17.7) and 16.9 years (IQR: 16.0-18.0) for first vaginal sex. Most men had engaged in oral sex (89.5%) and vaginal sex (91.6%) in the previous 12 months with 32.6% reporting condom use at last vaginal sex. Of the total lifetime female partners for vaginal sex reported by men as a group (n=1187): 54.3% (n=645) were the same age as the man, 28.3% (n=336) were a year or more younger and 17.4% (n=206) were a year or more older. Prior anal sex with females was reported by 22% with 47% reporting condom use at last anal sex. Median age at first anal sex was 18.2 years (IQR: 17.3-18.8). Anal sex with a female was associated with having five or more lifetime female sexual partners for oral and vaginal sex. CONCLUSIONS These data provide insights into the trajectory of sexual behaviours experienced by teenage heterosexual boys following sexual debut, findings which can inform programme promoting sexual health among teenage boys.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia
| | - Charlotte Bell
- Clinic 275, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mandy Johnson
- Family Planning Victoria, Melbourne, Victoria, Australia
| | - Lewis Marshall
- South Terrace Clinic, Fremantle Hospital, Perth, Western Australia, Australia
| | - David G Regan
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Louise Owen
- Sexual Health Service Tasmania, Tasmania, Australia
| | - Julia M L Brotherton
- National HPV Vaccination Program Register, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Queensland Health, Cairns, North Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
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48
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Brotherton JML, Bloem PN. Population-based HPV vaccination programmes are safe and effective: 2017 update and the impetus for achieving better global coverage. Best Pract Res Clin Obstet Gynaecol 2017; 47:42-58. [PMID: 28986092 DOI: 10.1016/j.bpobgyn.2017.08.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/27/2017] [Indexed: 01/11/2023]
Abstract
Persistent oncogenic human papillomavirus (HPV) is the cause of cervical cancer, as well as cancers of the anus, penis, vulva, vagina and oropharynx. There is good evidence that prophylactic HPV vaccines are immunogenic and effective against targeted-type HPV infections and type-specific genital lesions, including high-grade cervical intraepithelial neoplasia (CIN), when administered prior to HPV infection. There is good evidence that HPV vaccines are safe in population usage, with the most frequent adverse event being injection-site reactions. There is evidence to support some cross-protection against non-targeted types occurring following the administration of HPV vaccines. There is limited evidence suggesting that HPV vaccines may be beneficial in preventing future disease in women treated for high-grade CIN. This chapter focuses on the accumulated evidence regarding the global use of the three licensed HPV vaccines including safety, immunogenicity, duration of protection, effectiveness, coverage to date and barriers to higher coverage.
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Affiliation(s)
- Julia M L Brotherton
- National HPV Vaccination Program Register, VCS, East Melbourne, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
| | - Paul N Bloem
- Expanded Programme of Immunization, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
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Brotherton JML, Tabrizi SN, Phillips S, Pyman J, Cornall AM, Lambie N, Anderson L, Cummings M, Payton D, Scurry JP, Newman M, Sharma R, Saville M, Garland SM. Looking beyond human papillomavirus (HPV) genotype 16 and 18: Defining HPV genotype distribution in cervical cancers in Australia prior to vaccination. Int J Cancer 2017; 141:1576-1584. [PMID: 28677147 DOI: 10.1002/ijc.30871] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/27/2017] [Accepted: 06/12/2017] [Indexed: 01/08/2023]
Abstract
Australia has implemented a high-coverage HPV vaccination program but has not, to date, established the distribution of HPV types that occur in cervical cancers in Australia. This information is important for determining the potential for cervical cancer prevention with both current and broader spectrum HPV vaccines. We analysed 847 cervical cancers diagnosed 2005 to 2015 in tertiary centres in the three most populous Australian states with resolution of specimens containing multiple HPV types using laser-capture microdissection. Archived FFPE tissue was reviewed by specialist pathologists, sandwich sectioned, and initially whole-tissue sections genotyped for HPV. Samples were first genotyped using SPF10-LiPA25 (version 1). Negative samples were screened with DNA ELISA kit HPV SPF10, followed by genotyping with SPF+ LiPA if ELISA positive. If still negative, samples were tested on a qPCR assay targeting the E6 region of HPV16, 18, 45 and 33. Of the 847 cancers (65.1% squamous, 28.7% adenocarcinoma, 4.3% adenosquamous, 2.0% other), 92.9% had HPV detected. Of the HPV-positive cancers, 607 of 787 (77.1%) contained HPV16 or 18, 125 of 787 (15.9%) contained HPV31/33/45/52 or 58, and 55 (7.0%) another HPV type. There was a strong correlation between HPV type and age, with younger women most likely to have HPV16/18 detected and least likely HPV negative. Our findings indicate that cervical cancers diagnosed in Australia more frequently contain HPV16/18 than in international series. This could be due to cervical screening in Australia increasing the proportion of adenocarcinomas, in which types 18 and 16 more strongly predominate, due to prevention of squamous cancers.
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Affiliation(s)
- Julia M L Brotherton
- Victorian Cytology Service Registries, East Melbourne, VIC, Australia.,School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, Regional HPV Reference Laboratory Network, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Samuel Phillips
- Department of Microbiology and Infectious Diseases, Regional HPV Reference Laboratory Network, The Royal Women's Hospital, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jan Pyman
- Department of Anatomical Pathology, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Alyssa M Cornall
- Department of Microbiology and Infectious Diseases, Regional HPV Reference Laboratory Network, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Neil Lambie
- Department of Anatomical Pathology, SEALS Pathology, Randwick, NSW, Australia
| | - Lyndal Anderson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, The University of Sydney, NSW, Australia
| | - Margaret Cummings
- Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Diane Payton
- Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - James P Scurry
- Department of Anatomical Pathology, Pathology North-Hunter, New Lambton Heights, NSW, Australia
| | - Marsali Newman
- Department of Anatomical Pathology, Austin Hospital, Heidelberg, VIC, Australia
| | - Raghwa Sharma
- Sydney Medical School, The University of Sydney, NSW, Australia.,Department of Anatomical Pathology, ICPMR Pathology, Westmead, NSW, Australia
| | - Marion Saville
- Victorian Cytology Service Registries, East Melbourne, VIC, Australia.,VCS Pathology, Victorian Cytology Service, Carlton, VIC, Australia
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, Regional HPV Reference Laboratory Network, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
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Brotherton JML, Jit M, Gravitt PE, Brisson M, Kreimer AR, Pai SI, Fakhry C, Monsonego J, Franceschi S. Eurogin Roadmap 2015: How has HPV knowledge changed our practice: Vaccines. Int J Cancer 2016; 139:510-7. [PMID: 26916230 PMCID: PMC7388730 DOI: 10.1002/ijc.30063] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 12/18/2022]
Abstract
This review is one of two complementary reviews that have been prepared in the framework of the Eurogin Roadmap 2015 to evaluate how knowledge about HPV is changing practices in HPV infection and disease control through vaccination and screening. In this review of HPV vaccine knowledge, we present the most significant findings of the past year which have contributed to our knowledge of the two HPV prophylactic vaccines currently in widespread use and about the recently licensed nonavalent HPV vaccine. Whereas anal cancer is dealt with in the companion mini-review on screening, we also review here the rapidly evolving evidence regarding HPV-associated head and neck cancer and priority research areas.
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Affiliation(s)
- Julia M L Brotherton
- National HPV Vaccination Program Register, VCS Registries, East Melbourne, Vic, Australia
- School of Population and Global Health, University of Melbourne, Vic, Australia
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Patti E Gravitt
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Marc Brisson
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | - Aimée R Kreimer
- Infections & Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
| | - Sara I Pai
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Carole Fakhry
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Johns Hopkins Outpatient Center, Baltimore, MD
| | | | - Silvia Franceschi
- International Agency for Research on Cancer, 69372 Lyon cedex 08, France
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