3 – Support countries in the Indo-Pacific region to scale up to meet the 2030 targets in support of the WHO strategy to eliminate cervical cancer as a public health problem

THREE

SUPPORT COUNTRIES IN THE INDO-PACIFIC REGION TO SCALE UP TO MEET THE 2030 TARGETS IN SUPPORT OF THE WHO STRATEGY TO ELIMINATE CERVICAL CANCER AS A PUBLIC HEALTH PROBLEM

THE COVID-19 PANDEMIC IS GOING TO HAMPER GLOBAL EFFORTS TO MAKE HPV VACCINATION AND HPV-BASED SCREENING AVAILABLE TO ALL GIRLS AND WOMEN

WE HAVE TO FIND INNOVATIVE WAYS TO OVERCOME THIS NEW CHALLENGE

SELF-COLLECTED SAMPLES RAPID POINT OF CARE TESTING AND SAME DAY TREATMENT WILL BE CRUCIAL TO PROVIDE SAFE AND COSTEFFECTIVE SCREENING FOR WOMEN LIVING IN REMOTE COMMUNITIES

On 17 November 2020, following the close of the 73rd World Health Assembly, the World Health Organization officially launched the Global Strategy to Accelerate the Elimination of Cervical Cancer.

The adoption of the strategy was co-led by Australia, which has a history of global leadership in cervical cancer prevention programs, technology and research. The HPV vaccine was developed at the University of Queensland by Professor Ian Frazer and the late Dr Jian Zhou, and in 2007 Australia introduced the world’s first nationwide HPV vaccination program. VCS Foundation is committed to support the Australian Government by identifying less well-resourced countries to scale up HPV vaccination and cervical screening. Using our expertise in laboratory, screening and registry services, VCS Foundation can offer solutions that are acceptable to and suitable for local populations and health systems.

MINDEROO PROJECT – A LANDMARK CERVICAL CANCER ELIMINATION PROGRAM IN THE WESTERN PACIFIC, PAPUA NEW GUINEA

The Minderoo Foundation together with NHMRC Centre of Research Excellence in Cervical Cancer Control (C4) announced a first-of-its-kind humanitarian and research effort to eliminate cervical cancer in the Western Pacific at the Preventing Cervical Cancer Conference in March 2021. The Western Pacific has among the highest rates of cervical cancer in the world, and there are an estimated 1,200 deaths in PNG alone every year. Human papillomavirus, or HPV, causes almost all cervical cancers worldwide. HPV infection and disease can be prevented by childhood vaccination, whilst screening women for HPV infection in adult life is highly effective in detecting early disease and preventing cervical cancer. Minderoo Foundation’s conditional grant of AU$8.1 million – when supported by additional funding and in-kind support from other partners – will provide almost $30 million to enable C4 and in-country partners to set Papua New Guinea and Vanuatu on the path to eliminating cervical cancer. The project aligns to the World Health Organization (WHO) strategy to eliminate cervical cancer worldwide by the end of the century, through a ‘triple-intervention’ approach for scale up of vaccination, screening and treatment (the 90/70/90 targets), which sets out three simple targets to place all countries on the path toward elimination by 2030: Within C4, this initiative has been led by Professor Karen Canfell, Director of Cancer Research at Cancer Council NSW; Professor Marion Saville, Executive Director, VCS Foundation; Professor Andrew Vallely, Kirby Institute UNSW Sydney and PNG Institute of Medical Research, Goroka; and Professor Deborah Bateson, Medical Director, Family Planning NSW. The project will put the WHO eliminate cervical cancer concept into practice, leading the world to show how the tripleintervention strategy of HPV vaccination, HPV-based screening and cancer treatment can be introduced into a priority region. It will create a sustainable framework for attracting additional partners and will act as a catalyst for cervical cancer elimination globally. VCS Foundation, as a lead member of C4, is proud to provide scientific, population health and digital health expertise and technology using the canSCREEN® population health management platform for this initiative. Partners will work with health officials in PNG and Vanuatu, leveraging opportunities to: + Build and prioritise existing health services + Fast-track HPV vaccines for girls and cervical screening for women in

PNG and Vanuatu and deliver training and equipment to build healthcare capacity + The Australian research arm will conduct modelling and analysis to inform the most efficient and effective ways to implement and then expand the initiative, and + The Eliminate Cervical Cancer in the

Western Pacific project will be core to a range of active and emerging regional and local partnerships in the

Western Pacific region, which will be essential to achieving cervical cancer elimination worldwide.

Caroline Henao, a cervical cancer survivor, patient advocate and Board Member of the Papua New Guinea Cancer Foundation, said the new initiative would deliver real change in women’s lives. “It would do so much in empowering women to have screening and to know that there is a way forward for them,” she said. “It would also encourage them to know this disease isn't a death sentence but very much curable if detected early.”

GLOBAL ALLIANCE FOR CHRONIC DISEASES (GACD) FUNDED PROJECTS

India

VCS Foundation is leading a project to implement self-collected HPV-based cervical cancer screening in vulnerable populations in urban and rural India. Funded through the GACD and the National Health and Medical Research Council (NHMRC), VCS Foundation was awarded a $1.33 million grant for a three-year research project implementing cervical cancer screening in hard-to-reach and vulnerable Indian communities.

India is the world’s second most populous nation where the burden of cervical cancer is high, at one-fifth of the total global burden. This equates to 60,000 Indian women dying from cervical cancer every year. Professor Julia Brotherton is leading the implementation research project with partners in two states of India, Tamil Nadu in Southern India and Mizoram in North-eastern India, along with experts on cancer and disease prevention from the International Agency for Research on Cancer, the Baker Heart and Diabetes Institute and RTI International.

Papua New Guinea

Building on previous collaborative and world-leading research supporting the use of HPV-based screen and treat for screening, Professor Andrew Vallely from the Kirby Institute at UNSW Sydney is leading a project on HPV testing and treatment for the elimination of cervical cancer in rural and remote Papua New Guinea. This $1.59 million project is complementary to the Minderoo project and is being conducted in collaboration with VCS Foundation (investigators Professor Marion Saville and Professor Julia Brotherton), Cancer Council NSW, Family Planning NSW, and the NHMRC Centre of Research Excellence in Cervical Cancer Control (C4), and in-country partners and stakeholders in PNG. VCS Foundation will support the project with our canSCREEN® registry platform plus our laboratory, epidemiological and screening expertise. The project will utilise the novel ‘test and treat’ screening model developed by our collaborative research team, comprising HPV testing of self-collected vaginal specimens followed by same-day treatment using a new battery operated, portable thermal ablation device. This approach proved highly effective, acceptable and cost-effective in previous field trials.

The team will now establish how best to reach women in rural and remote communities, where cervical pre-cancer and cancer rates are highest, access to health services most constrained, and the most at-risk women in PNG and other high-burden, low-resource countries live.

NHMRC and GACD funded project in Jawadhi Hills, India. From left to right: Mrs Indrani, Mrs Kavitha, Mrs Revathi (tribal health worker), Mrs Mala (tribal diploma nurse)

Professor Julia Brotherton, MEDICAL DIRECTOR VCS POPULATION HEALTH ‘In a country as complex and large as India, we know there are significant challenges in scaling up preventive health services, particularly in rural and remote areas serving vulnerable Indian women. Cervical cancer is preventable and this research will play a critical role in identifying the key challenges in reaching women to screen, as well as supporting their follow up when treatment is needed.’

PROJECT ECHO: WORKING TOGETHER TO SHARE KNOWLEDGE AND EMERGING SOLUTIONS TO MEET ELIMINATION SCALE-UP TARGETS FOR ALL WOMEN IN OUR REGION

Project ECHO (Extension for Community Healthcare Outcomes) is a movement to share knowledge and amplify local capacity to provide best practice care for people all over the world. We utilise the ECHO model™ to provide peer-to-peer and expert support to multi-sectorial country teams in the Indo-Pacific answering the WHO call to scale up cervical cancer prevention to eliminate cervical cancer as a public health problem (<4 per 100,000). The SUCCESS (Scale Up for Cervical Cancer Elimination Strategy Success) in the Indo-Pacific ECHO aims to provide ongoing, monthly consultations with practitioners seeking and contributing peer advice and expert input regarding the challenges faced when scaling up to reach the 2030 goals. In establishing the SUCCESS ECHO, we invited and expanded upon the existing community of practice established by the US National Cancer Institute (NCI) in its 2017-18 APEC cervical cancer prevention ECHO. Using ZOOM, we hold a monthly tele-mentoring session to provide a sustained exchange opportunity with the motto ‘All teach, all learn’. Over 90 minutes, following a short didactic from an expert with discussion, participating country teams, including both WPRO and SEARO WHO region countries, present case studies from their program or scale up projects for feedback and ideas from regional colleagues and international experts. Monthly session themes alternate between the three elimination pillars of screening, treatment and vaccination.

Over 230 colleagues from across the region and beyond are signed up to SUCCESS, with 22 sessions held to date. Attendance has been high despite COVID-19, ranging from 18 to 75 participants per session, with an average of 33 attendees per session. Participants are from at least 35 countries and include clinicians, researchers, Ministry of Health staff and NGOs.

SUCCESS ECHO is supporting shared learning in relation to elimination and building ongoing networks and collaborations between participants. PARTICIPATING COUNTRIES

NO OF ATTENDEES

India

Myanmar Malaysia Sri Lanka

Taiwan

Australia

USA

Papua New Guinea Palau 91

22

17

14

11

11

9

9

7

New Zealand 7

Brunei 6 Switzerland (Geneva) 6 China 5 Japan 4 Singapore 4 Viet Nam 4 Unknown 4 Mongolia 3 Philippines 3 British Columbia 2 Nepal 2 Thailand 2 Botswana 1 Cambodia 1 Cook Islands 1 England 1 Fiji Islands 1 France 1 Germany 1 Hong Kong 1 Indonesia 1 Kenya 1 Maldives 1 Samoa 1 Spain 1 Sweden 1