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

Abstract

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

Current global status & impact of human papillomavirus vaccination

“…More than 80 countries have introduced HPV vaccine in the NIPs, of which 33 are LMICs; in addition, 25 LMICs have introduced HPV vaccination in pilot demonstration programmes as a prelude to national scaling up in NIPs (Table II)3940. Many Pacific Island nations have implemented HPV vaccination41. In most programmes, a school-based approach is predominantly used to deliver the vaccine to the targeted adolescents with additional efforts using field clinics, and primary health centres to cover girls who missed vaccination and do not attend schools.…”

Cervical Cancer Screening in the United States–Affiliated Pacific Islands

“…19,20 In the USAPI island communities, cervical cancer screening using cytology-based methods is a primarily opportunistic screening and is less widely accessed and less successful as a strategy than in the United States as a whole. 21,22 This model is labor intensive and costly and requires an organized follow-up system, maintenance of supplies and equipment, and regular training of staff. The logistics of transportation, physical community outreach, timely communication, and disease management makes the model of cytology and colposcopy impractical for many of these communities.…”

Randomized controlled trial evaluating the utility of urine HPV DNA for cervical cancer screening in a Pacific Island population

“…4 The high burden of cervical cancer in Yap is consistent with low levels of screening, which remain at less than 40% throughout the FSM. 5 Major barriers to cervical cancer screening in Yap include geography, lack of trained personnel, limited clinical resources, as well as issues of cultural and personal acceptability. 5 Primary health care is provided through a hospital and public health clinics on the main Yap island and, for the outer islands, through small health dispensaries run by health assistants and equipped with variable electricity and limited supplies and medication.…”

“…5 Major barriers to cervical cancer screening in Yap include geography, lack of trained personnel, limited clinical resources, as well as issues of cultural and personal acceptability. 5 Primary health care is provided through a hospital and public health clinics on the main Yap island and, for the outer islands, through small health dispensaries run by health assistants and equipped with variable electricity and limited supplies and medication. Cervical cancer screening, largely comprised of cytology (Pap testing) and visual inspection with acetic acid (VIA), is available on the main island and, sporadically, on the outer islands by traveling public health teams.…”

“…Cervical cancer screening, largely comprised of cytology (Pap testing) and visual inspection with acetic acid (VIA), is available on the main island and, sporadically, on the outer islands by traveling public health teams. 5 Follow-up colposcopy and biopsy as well as treatment for precancerous and early stage cervical cancer are also available on the main island with more advanced stage cancers referred to medical facilities off-island. 5 For low-resource communities like Yap, the need for more culturally-, resource-, and health workforce-appropriate methods of cervical cancer screening has been recognized.…”