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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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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) www.ncirs.usyd.edu.au 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>

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