Service Providers of HPV vaccination for Aboriginal and Torres Strait Islander Australian Females


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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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  • Australia we define an indigenous person As someone who has a blood line , they identify as A TSI and they are accepted by their community in which they live and or work
  • indigenous australia is made up of 2 vastly different groups of people the TSI is situated in most northern point of the eastern side of the country…. And is part of the state of queensland TSI is made up of nearly 300 islands that make stepping stones from Aust up to Papua New Guinea And the big continent of Australia is the land that we the Aboriginal people belong Aust is segregated into states and territories………..loosely shown by the black lines
  • Within Australia there is a false assumption of where Aboriginal people live and because Aboriginal people are easy to identify in the NT it is thought that this is where the majority live But this slide show’s that the total population in the NT is less than the urban population in Sydney which is Australia’s biggest city.
  • This age/sex pyramid comparing Aboriginal to non-Aboriginal the majoity of the Aboriginal pop is in the under 30’s age group while non-Aboriginal Australians has an aging population
  • Australia is has a well established cervical screening program that started in 1991 it includes a pap register that women can opt off . So with this history of poor or no cervical screening resulting in rates of mortality at least 3 time that to Non Indigenous Australian women it stands to reason that being able to provide good HPV vaccine coverage in the Indigenous female population is full of positive possibilities
  • A fully funded HPV vaccination program was announced by the Government in november 2006 to roll out a three dose schedule of Gardisil In a three tired program
  • Indigenous people will access AMS, Public health and GP’s but a report by the national aboriginal Community controlled health organisation stated that the majority of aboriginal people will attend an ams if they can physically get there There are over 200 AmS now but not all of them provide a clinical service or if they do they may not have a Nurse immuniser or Dr
  • like to talk about what some of the challenges have been for HPV vaccine roll out and also factors that have facilitated or could help facilitate the process to gain good coverage Having good resources staff and equipment ie car pool improve service provision for many ams but they are still working at capacity with full waiting rooms… also pts might come in with multiple chronic health issues so it might be hard to address all the issues in one consultation and then if another visit is needed will they come. While AMS were targeting 18 to 26 yr old they were also trying to follow up on those 12-18 who were no longer at school. So what ever instability affected their attendance to school may also affect individuals accessing health provision Swine flu affected Australia at the same time that service providers where asked to follow up on pt to initiate 1 st dose so that the 3 dose could be done within the funded period and also to ensure that the last dose was given
  • Please contact me if you wish to discuss this slide
  • Each S&T is pretty autonomous in how it provides health care Public health provide childhood immunisation clinics and school based programs for rubella, boosterix and HPV
  • Attendance for Indigenous secondary students according is lower than non-Indigenous students 15-17 yrs of age. At 15 yrs, 73% of Indigenous students compared to 89% of non-Indigenous attend school (ABS 2006). By 17 years of age this fell to 36% for Indigenous while non-Indigenous retention is 66%. Consistency of attendance is also an important issue with Herbert et al (1999) reporting that suspension and exclusion from secondary school is disproportionately high for Indigenous students. These are issues to be aware of with the HPV vaccine school based program
  • Relying on a good return of parental endorsement via consent forms sent home with female students (12-18 years old) and consistently good attendance at school is the crux of a school based program. Substantially higher levels of consent from parents of Indigenous children have been achieved through collaboration between local schools and Tharawal Aboriginal Corporation, in Campbelltown Sydney. These included the employment of an Aboriginal Education Liaison Officer, collaboration with an Aboriginal Health Worker, and assistance with transport to gather consent forms prior to school visits. (Personal communication, Clyde William, Senior Aboriginal Health Worker, Tharawal Aboriginal Corporation).
  • Identification of Indigenous status – if a GP asks Indigenous status then he is able to provide a more comprehensive health service – medicare funding (Government) for extending consultation times – to address multiple health issues Follow up of school based program – potential follow up of girls who have left the school system For the HPV Register – collection of status to report to the register Know barriers Cultural comfort – history or ‘bad things happen’ in the health setting – ie stolen generation Physical access – travel, urban or rural – looking after children
  • HPV vaccine delivery in Australia was not strait forward and it took the time and imagination of many different disciplines to roll it out. Like other countries H1N1 acutely compromised our health care system shifting priorities We are eager to see how we have done
  • Service Providers of HPV vaccination for Aboriginal and Torres Strait Islander Australian Females

    1. 1. Ms Telphia-Leanne Joseph National Indigenous Immunisation Coordinator Dr Robert Menzies Manager, Indigenous/Migrant Health and Program Evaluation Director (Surveillance) Service Providers of HPV vaccination for Aboriginal and Torres Strait Islander Australian Females
    2. 2. Discussions for today <ul><li>Background </li></ul><ul><ul><li>Indigenous Australia </li></ul></ul><ul><ul><li>HPV vaccine delivery </li></ul></ul><ul><li>Challenges and factors that have/could affected HPV vaccine service provision for Indigenous females </li></ul>
    3. 3. Definition of Aboriginal / Torres Strait Islander <ul><li>A person of Aboriginal or Torres Strait Islander descent who identifies as an Aboriginal or Torres Strait Islander and is accepted as such by the community in which he or she lives'. </li></ul>
    4. 4. Torres Strait Islanders 33,300 Aboriginal Australians 463,700
    5. 5. Indigenous Population Distribution by Jurisdiction, Australia 2006 ABS
    6. 6. Age sex comparison pyramid Indigenous vs non-Indigenous ABS 2006
    7. 7. HPV Vaccine for Australian Indigenous Females <ul><li>ICC affects Indigenous women at least 4 times greater than non-Indigenous Australian females </li></ul><ul><li>Inconsistent, late or nil presentation for pap testing </li></ul><ul><ul><li>Australia has a well established cervical screening program </li></ul></ul><ul><ul><ul><li>Pap register </li></ul></ul></ul><ul><li>Indigenous females are good candidates for HPV vaccination </li></ul>
    8. 8. HPV vaccine roll-out in Australia Three – Tiered Program 12-13 year olds School based program Annually 13-18 year olds School based catch-up program Ending late 2009 16-18 year olds not at school 18-26 year olds General practice and Community providers Ending late 2009
    9. 9. Service providers for Indigenous Communities – Aboriginal Medical Services (AMS) <ul><li>Over 200 community controlled organisations </li></ul><ul><ul><li>Urban, rural and remote </li></ul></ul><ul><li>Not all provide a clinical service </li></ul><ul><li>Government funded </li></ul><ul><li>Wholistic philosophy </li></ul><ul><ul><li>Healthy mind, spirit, body, land, community </li></ul></ul>
    10. 10. Aboriginal Medical Services – Factors affecting HPV vaccination for 15-26 year olds <ul><li>Challenges </li></ul><ul><li>Acute service provision </li></ul><ul><li>Those out of school system </li></ul><ul><li>H1N1 </li></ul><ul><li>Facilitators </li></ul><ul><li>They believed in HPV vaccination </li></ul><ul><li>They often know their community </li></ul><ul><li>Patient Information Recall Systems (PIRS) </li></ul>
    11. 11. Patient presents Entered on PIRS, produce recall flags Triage assessment Vaccination Recall and mail outs Targeted outreach Screening, management of chronic diseases, etc. Integrated Primary Health Care Management
    12. 12. Service providers for Indigenous Communities – Public Health <ul><li>State and Territory Governments - funded federally </li></ul><ul><ul><li>Immunisation clinics, school based programs </li></ul></ul><ul><li>Aboriginal Health Services WA, NT & QLD </li></ul><ul><ul><li>Very remote </li></ul></ul><ul><ul><li>Not community controlled </li></ul></ul>
    13. 13. Factors affecting HPV vaccination in school based program <ul><li>Challenges </li></ul><ul><li>Attendance </li></ul><ul><ul><li>Low rates of attendance in high school ages 15-17 yrs </li></ul></ul><ul><ul><li>73% at 15 yrs </li></ul></ul><ul><ul><li>36% by 17 yrs </li></ul></ul><ul><li>Consistency of attendance </li></ul><ul><ul><li>Disproportionately high </li></ul></ul><ul><ul><ul><li>Suspension and exclusion from school </li></ul></ul></ul>
    14. 14. school based program - continued <ul><li>Consent forms </li></ul><ul><ul><li>Inconsistent return rate </li></ul></ul><ul><li>Collaboration can change this </li></ul><ul><li>Ear health program in Campbelltown </li></ul><ul><li>Public health staff, Aboriginal health worker, Aboriginal liaison education staff </li></ul><ul><ul><li>Shared resources </li></ul></ul><ul><ul><li>Knew their community </li></ul></ul><ul><ul><li>Door knocked </li></ul></ul><ul><li>94% consent </li></ul>
    15. 15. Service providers for Indigenous Communities – General Practice <ul><li>General Practice Networks each S&T </li></ul><ul><li>Individual practices or medical centres </li></ul><ul><ul><li>Acute care </li></ul></ul><ul><ul><li>Health plans </li></ul></ul><ul><li>Medicare at their discretion </li></ul>
    16. 16. General Practice - Factors affecting HPV vaccination for 15-26 year olds <ul><li>Challenges </li></ul><ul><li>Identification of Indigenous status </li></ul><ul><ul><li>For the HPV Register </li></ul></ul><ul><ul><li>Follow up of school based program </li></ul></ul><ul><ul><li>Know barriers </li></ul></ul><ul><ul><ul><li>Cultural comfort </li></ul></ul></ul><ul><ul><ul><li>Physical access </li></ul></ul></ul>
    17. 17. General Practice - Factors affecting HPV vaccination for 15-26 year olds <ul><li>Facilitates </li></ul><ul><li>Knowing community </li></ul><ul><li>Good use of Medical Software </li></ul><ul><li>Identification! Identification! Identification! </li></ul>
    18. 18. Conclusion <ul><li>HPV vaccine delivery </li></ul><ul><ul><li>Its not straight forward </li></ul></ul><ul><ul><li>Many worked hard </li></ul></ul><ul><ul><li>H1N1 </li></ul></ul><ul><li>Awaiting coverage results </li></ul>
    19. 19. ACKNOWLEDGMENTS <ul><li>Dr Julia Brotherton </li></ul><ul><li>Dr Robert Menzies </li></ul>