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

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26th International Papillomavirus Conference: Satellite Symposium …

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.



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  • 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
  • Transcript

    • 1. Prevention of HPV Diseases in Indigenous Populations Examples of promising interventions and activities for Alaska Natives and American Indians
      Eileen Dunne MD, MPH
      Division of STD Prevention, CDC
      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
    • 2. Diverse people, cultures, languages, and lifestyles
      Photos Courtesy of the Indian Health Service/U.S. Department of Health and Human Services and the Alaska Native Tribal Health Consortium  
    • 3. American Indian and Alaska Native Population by State
      WA
      NH
      ME
      VT
      MT
      ND
      MN
      OR
      MA
      ID
      SD
      WI
      NY
      RI
      MI
      WY
      PA
      CT
      CA
      NV
      NE
      NJ
      OH
      IN
      IL
      UT
      WV
      DE
      CO
      KS
      MO
      VA
      MD
      KY
      NC
      TN
      AZ
      NM
      OK
      AR
      SC
      AI/AN Population
      by State, 2000
      GA
      AL
      TX
      MS
      LA
      100,00 to 333,400
      FL
      50,000 to 99,999
      AK
      10,000 to 49,999
      1,713 to 9,999
      HI
      Source: Census 2000, One race (AI/AN) alone
      http://www.census.gov/population/cen2000/atlas/censr01-107.pdf
    • 4. Outline
      American Indian and Alaska Native sovereignty and health care delivery
      Cervical cancer burden in American Indian and Alaska Natives
      Promising interventions for Cervical Cancer Prevention
      HPV vaccine
      Cervical Cancer Screening
    • 5. The Federal - Tribal Relationship
      Is unique and is expressed through:
      Recognition of Tribal sovereignty
      Government to government interactions
      Support of the Federal trust responsibility
      Tribal consultation
    • 6. Background: Health care for AI/AN
      AI/AN have sovereignty and self-governance
      Indian Health Service (IHS) provides health services to AI/AN
      comprehensive health service delivery system for approximately 1.9 million AI/AN who belong to 560+ federally recognized tribes in 35 states
      Members of these tribes are eligible to receive, without charge, primary healthcare from IHS
      Self governance contracts with tribal governments in some settings
      Private/public clinics outside IHS also used depending on employment, Veterans benefits, Medicaid, Medicare
    • 7. Burden of HPV-AssociatedDiseases/Cancers
      Genital warts
      Recurrent respiratory papillomatosis
      Cervical cancers
      Vaginal/Vulvar cancers
      Anal cancers
      Penile cancers
      Oropharyngealand
      Oral Cavity cancers
      > 90% HPV 6, 11
      ~30-80% HPV 16, 18
    • 8. BackgroundBurden of HPV-associated Cervical Cancers, AI/AN
      Considerable misclassification of race/ethnicity
      Regional variations in cervical cancers
      Highest age-adjusted rates reported in Southern Plains (14.1 per 100,000) and Northern Plains (12.5 per 100,000)
      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
      Becker TM, Cancer 2008
    • 9. Interventions to reduce HPV-associated cancers
      HPV Vaccine implementation
      Implementation status as of beginning of 2010
      School based vaccine implementation project
      Evaluation of HPV Vaccine Impact
      Cervical cancer screening
      Northern Plains evaluation of cervical self-sampler
    • 10. HPV Vaccine Coverage Adolescent Females NIS, 2008
      MMWR Sept 18, 2009;58(36);997-1001
    • 11. HPV Vaccine Immunization Coverage, IHS Data
    • 12. Fort Berthold HPV Vaccine Implementation Project
      Fort Berthold Reservation: Affiliated Tribes Mandan, Hidatsa, and Arikara
      5 School Districts in Tribal Areas participated
      Meetings with parents/schools, education materials
      Permission slips collected from parents before the beginning of the school year
      Snacks, incentives provided—combined with a nutrition/exercise program
      138 girls completed series, 453 doses distributed
      Intention is to expand this program next school year
    • 13. Arctic Investigations Program, CDCAnchorage, AK
      Collaboration with Alaska Native Tribal Health Consortium and Southcentral Foundation, CDC is conducting projects to measure HPV vaccine impact in Alaska Natives
      HPV genotypes in women at time of coloposcopy
      Immunogenicity and duration of immunity among teens receiving HPV vaccine
      HPV genotypes in archived cervical cancer
      Development of AN specific education materials based on focus groups
    • 14. HPV types Causing Cervical Cancers in Alaska Native Women
      P-810
      “Prevalence of HPV types in archived cervical cancer specimens from Alaska Native women, 1980-2007”
    • 15. HPV types detected in Cervical Cancers, Alaska Native Women, 1980-2007
    • 16. Northern PlainsCervical Cancer Screening Project
      Challenges in rural and underserved settings for cervical cancer screening
      Time constraints, travel, childcare
      In Aberdeen Area, less than 1/3 of AI women have annual Pap screening
      This project is a collaboration between Native Plains NARCH, the Tribal Chairman’s Health Board, University South Dakota
      Goal is to evaluate if cervical self-sampler can improve experiences of cervical cancer screening in Northern Plains AI women
    • 17. HPV self-sampling to improve cervical cancer screening in AI communitiesStudy evaluation
      Women in tribal settings presenting for cervical cancer screening recruited
      Each woman will have a traditional Pap smear and HPV testing
      Teaching session on how to administer self-sampler
      Woman self collects sample at home, 30 and 90 days later
      Evaluation of acceptability, validity
    • 18. HPV Vaccination of Boys
      P-734
      Survey of IHS providers about intentions to vaccinate boys
    • 19. Thanks!American Indian and Alaska Native men, women and children and..
      IHS
      David Espey
      John Redd
      Amy Groom
      AIP, CDC
      Tom Hennessy
      Mike Bruce
      Janet Kelly
      Neil Murphy
      Fort Berthold
      Jared Eagle
      Debbie Jeanotte
      Northern Plains NARCH
      Delf Schmidt-Grimminger
      CDC
      Lauri Markowitz
      Elizabeth Unger
      Lori De Ravello
      Melanie Taylor
      Southcentral Foundation
    • 20. Thanks
      Eileen F. Dunne
      dde9@cdc.gov

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