Prevention of HPV Diseases in Indigenous Populations Examples of promising interventions and activities for Alaska Natives...
Diverse people, cultures, languages, and lifestyles<br />Photos Courtesy of the Indian Health Service/U.S. Department of H...
American Indian and Alaska Native Population by State<br />WA<br />NH<br />ME<br />VT<br />MT<br />ND<br />MN<br />OR<br /...
Outline<br />American Indian and Alaska Native sovereignty and health care delivery<br />Cervical cancer burden in America...
The Federal - Tribal Relationship<br />Is unique and is expressed through:<br />Recognition of Tribal sovereignty<br />Gov...
Background: Health care for AI/AN<br />AI/AN have sovereignty and self-governance<br />Indian Health Service (IHS) provide...
Burden of HPV-AssociatedDiseases/Cancers<br />Genital warts<br />Recurrent respiratory                                    ...
BackgroundBurden of HPV-associated Cervical Cancers, AI/AN<br />Considerable misclassification of race/ethnicity<br />Regi...
Interventions to reduce HPV-associated cancers<br />HPV Vaccine implementation<br />Implementation status as of beginning ...
HPV Vaccine Coverage     Adolescent Females NIS, 2008<br />MMWR Sept 18, 2009;58(36);997-1001<br />
HPV Vaccine Immunization Coverage, IHS Data<br />
Fort Berthold HPV Vaccine Implementation Project<br />Fort Berthold Reservation: Affiliated Tribes Mandan, Hidatsa, and Ar...
Arctic Investigations Program, CDCAnchorage, AK<br />Collaboration with Alaska Native Tribal Health Consortium and Southce...
HPV types Causing Cervical Cancers in Alaska Native Women<br />P-810<br />   “Prevalence of HPV types in archived cervical...
HPV types detected in Cervical Cancers, Alaska Native Women, 1980-2007<br />
Northern PlainsCervical Cancer Screening Project<br />Challenges in rural and underserved settings for cervical cancer scr...
HPV self-sampling to improve cervical cancer screening in AI communitiesStudy evaluation	<br />Women in tribal settings pr...
HPV Vaccination of Boys<br />P-734<br />Survey of IHS providers about intentions to vaccinate boys<br />
Thanks!American Indian and Alaska Native men, women and children and..<br />IHS<br />David Espey<br />John Redd<br />Amy G...
Thanks<br />Eileen F. Dunne<br />dde9@cdc.gov<br />
Upcoming SlideShare
Loading in …5
×

Prevention of HPV Diseases in Indigenous Populations: Examples of promising interventions and activities for Alaska Natives and American Indians

3,223 views

Published on

26th International Papillomavirus Conference: Satellite Symposium
Enhancing HPV Prevention among Indigenous Populations: International Perspectives on Health and Well-Being
Montreal, Quebec
July 5, 2010

Panel 2: Primary and Secondary Prevention of HPV Diseases, Cervical and other cancers among Indigenous Populations: Promising Interventions and Wise Practices.



Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
3,223
On SlideShare
0
From Embeds
0
Number of Embeds
295
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Indigenous People are a diverse people with different cultures, languages and lifestyles—hear are just a few pictures of AI/AN ceremonies and peoples. I thought for the purposes of talking about some HPV-related projects I would first talk a bit about where americanindian and alaska natives live and how they get health care.
  • American Indian and Alaska Native sovereignty and health care deliveryCervical cancer burden in American Indian and Alaska NativesPromising interventions for Cervical Cancer PreventionHPV vaccineCervical Cancer Screening
  • Healthcare for AI/AN differs by setting—but some important principles apply, and there is one system in place. AI/AN have sovereignty and self-governance (based on treaties, constitution)Indian Health Service (IHS) provides majority of health services to AI/ANcomprehensive health service delivery system for approximately 1.9 million AI/AN who belong to 560+ federally recognized tribes in 35 states (about ~57% of healthcare for AI/AN)Members of these tribes are eligible to receive, without charge, primary healthcare from HISSelf governance contracts with tribal governments in some settings (AK)Private/public clinics outside IHS also used depending on employment, Veterans benefits, Medicaid, Medicare
  • Prevention of HPV Diseases in Indigenous Populations: Examples of promising interventions and activities for Alaska Natives and American Indians

    1. 1. Prevention of HPV Diseases in Indigenous Populations Examples of promising interventions and activities for Alaska Natives and American Indians<br />Eileen Dunne MD, MPH<br />Division of STD Prevention, CDC<br />The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention <br />
    2. 2. Diverse people, cultures, languages, and lifestyles<br />Photos Courtesy of the Indian Health Service/U.S. Department of Health and Human Services and the Alaska Native Tribal Health Consortium  <br />
    3. 3. American Indian and Alaska Native Population by State<br />WA<br />NH<br />ME<br />VT<br />MT<br />ND<br />MN<br />OR<br />MA<br />ID<br />SD<br />WI<br />NY<br />RI<br />MI<br />WY<br />PA<br />CT<br />CA<br />NV<br />NE<br />NJ<br />OH<br />IN<br />IL<br />UT<br />WV<br />DE<br />CO<br />KS<br />MO<br />VA<br />MD<br />KY<br />NC<br />TN<br />AZ<br />NM<br />OK<br />AR<br />SC<br />AI/AN Population<br />by State, 2000<br />GA<br />AL<br />TX<br />MS<br />LA<br />100,00 to 333,400<br />FL<br />50,000 to 99,999<br />AK<br />10,000 to 49,999<br />1,713 to 9,999<br />HI<br />Source: Census 2000, One race (AI/AN) alone<br />http://www.census.gov/population/cen2000/atlas/censr01-107.pdf<br />
    4. 4. Outline<br />American Indian and Alaska Native sovereignty and health care delivery<br />Cervical cancer burden in American Indian and Alaska Natives<br />Promising interventions for Cervical Cancer Prevention<br />HPV vaccine<br />Cervical Cancer Screening<br />
    5. 5. The Federal - Tribal Relationship<br />Is unique and is expressed through:<br />Recognition of Tribal sovereignty<br />Government to government interactions<br />Support of the Federal trust responsibility<br />Tribal consultation<br />
    6. 6. Background: Health care for AI/AN<br />AI/AN have sovereignty and self-governance<br />Indian Health Service (IHS) provides health services to AI/AN<br />comprehensive health service delivery system for approximately 1.9 million AI/AN who belong to 560+ federally recognized tribes in 35 states<br />Members of these tribes are eligible to receive, without charge, primary healthcare from IHS<br />Self governance contracts with tribal governments in some settings <br />Private/public clinics outside IHS also used depending on employment, Veterans benefits, Medicaid, Medicare<br />
    7. 7. Burden of HPV-AssociatedDiseases/Cancers<br />Genital warts<br />Recurrent respiratory papillomatosis<br />Cervical cancers<br />Vaginal/Vulvar cancers<br />Anal cancers<br />Penile cancers<br />Oropharyngealand<br /> Oral Cavity cancers<br />> 90% HPV 6, 11<br />~30-80% HPV 16, 18<br />
    8. 8. BackgroundBurden of HPV-associated Cervical Cancers, AI/AN<br />Considerable misclassification of race/ethnicity<br />Regional variations in cervical cancers <br />Highest age-adjusted rates reported in Southern Plains (14.1 per 100,000) and Northern Plains (12.5 per 100,000)<br />Overall higher rates of cervical cancer than non Hispanic White women (9.4 per 100,000), and more likely to be diagnosed at later stage of disease<br />Becker TM, Cancer 2008<br />
    9. 9. Interventions to reduce HPV-associated cancers<br />HPV Vaccine implementation<br />Implementation status as of beginning of 2010<br />School based vaccine implementation project<br />Evaluation of HPV Vaccine Impact<br />Cervical cancer screening <br />Northern Plains evaluation of cervical self-sampler<br />
    10. 10. HPV Vaccine Coverage Adolescent Females NIS, 2008<br />MMWR Sept 18, 2009;58(36);997-1001<br />
    11. 11. HPV Vaccine Immunization Coverage, IHS Data<br />
    12. 12. Fort Berthold HPV Vaccine Implementation Project<br />Fort Berthold Reservation: Affiliated Tribes Mandan, Hidatsa, and Arikara<br />5 School Districts in Tribal Areas participated<br />Meetings with parents/schools, education materials<br />Permission slips collected from parents before the beginning of the school year <br />Snacks, incentives provided—combined with a nutrition/exercise program<br />138 girls completed series, 453 doses distributed<br />Intention is to expand this program next school year<br />
    13. 13. Arctic Investigations Program, CDCAnchorage, AK<br />Collaboration with Alaska Native Tribal Health Consortium and Southcentral Foundation, CDC is conducting projects to measure HPV vaccine impact in Alaska Natives<br />HPV genotypes in women at time of coloposcopy<br />Immunogenicity and duration of immunity among teens receiving HPV vaccine<br />HPV genotypes in archived cervical cancer<br />Development of AN specific education materials based on focus groups<br />
    14. 14. HPV types Causing Cervical Cancers in Alaska Native Women<br />P-810<br /> “Prevalence of HPV types in archived cervical cancer specimens from Alaska Native women, 1980-2007”<br />
    15. 15. HPV types detected in Cervical Cancers, Alaska Native Women, 1980-2007<br />
    16. 16. Northern PlainsCervical Cancer Screening Project<br />Challenges in rural and underserved settings for cervical cancer screening<br />Time constraints, travel, childcare<br />In Aberdeen Area, less than 1/3 of AI women have annual Pap screening<br />This project is a collaboration between Native Plains NARCH, the Tribal Chairman’s Health Board, University South Dakota<br />Goal is to evaluate if cervical self-sampler can improve experiences of cervical cancer screening in Northern Plains AI women<br />
    17. 17. HPV self-sampling to improve cervical cancer screening in AI communitiesStudy evaluation <br />Women in tribal settings presenting for cervical cancer screening recruited<br />Each woman will have a traditional Pap smear and HPV testing<br />Teaching session on how to administer self-sampler<br />Woman self collects sample at home, 30 and 90 days later <br />Evaluation of acceptability, validity<br />
    18. 18. HPV Vaccination of Boys<br />P-734<br />Survey of IHS providers about intentions to vaccinate boys<br />
    19. 19. Thanks!American Indian and Alaska Native men, women and children and..<br />IHS<br />David Espey<br />John Redd<br />Amy Groom<br />AIP, CDC<br />Tom Hennessy<br />Mike Bruce<br />Janet Kelly<br />Neil Murphy<br />Fort Berthold<br />Jared Eagle<br />Debbie Jeanotte<br />Northern Plains NARCH<br />Delf Schmidt-Grimminger<br />CDC<br />Lauri Markowitz<br />Elizabeth Unger<br />Lori De Ravello<br />Melanie Taylor<br />Southcentral Foundation<br />
    20. 20. Thanks<br />Eileen F. Dunne<br />dde9@cdc.gov<br />

    ×