HPV self-testing is working, let’s celebrate the progress - Gabrielle Lord

The HPV self-testing rollout is a significant step forward, writes Gabrielle Lord. Photo / Getty Images

THE FACTS:

• Cervical cancer is one of the few cancers that is almost entirely preventable.
• We’ve reached the two-year anniversary of the HPV Primary Screening programme being introduced.
• We need to celebrate the progress made so far, but build on the momentum and progress to-date.
• The HPV self-testing rollout is a significant step forward - but more needs to be done.

Cervical cancer is one of the few cancers that is almost entirely preventable – and in Aotearoa, we’re making real progress toward that goal.

While recent commentary has raised concerns about the rollout of HPV self-testing, the reality is that as we’ve reached the two-year anniversary of the HPV Primary Screening programme being introduced, the programme is delivering strong results, especially for those communities who have historically been under-served.

Since the rollout began, at ProCare, New Zealand’s largest PHO, we’ve seen a significant uplift in screening rates across our 143 practices. Our total screening for all women increased by 8.77% (from 62.77% to 71.47%), but for our traditionally under-served populations, the gains were even greater. We saw a 13.43% increase for Māori women (up from 56.22% to 69.65%) and a 15.72% increase for Pacific women (from 50.46% to 66.18%).

We acknowledge the leadership and great commitment from our general practice teams, as these are not just numbers. Instead, they represent the thousands of women who are now better protected against cervical cancer which is a fantastic result for women across the motu.

Of course, there is still more to do – but it is worth celebrating the progress we’ve made to date.

What’s driving this success?

Best practice lies in being grounded in equity, empathy and empowerment, which results in saving lives.

Practical and tangible actions provide a blueprint for success. Some of these steps we’ve taken to help our practices achieve these results include:

• Clear communication: We’ve encouraged our practices to let patients know they’re eligible for the HPV self-swab, not just a smear, and ensure they understand the process to reduce fear, confusion or whakamā (embarrassment). We also recommend the use of simple, plain language, for example, “We can show you how you can do the test yourself in private.”
• Culturally safe care: We’ve helped practices create culturally safe spaces by ensuring the basics are done well, such as greeting patients in their own language and ensuring names are pronounced correctly, and we offer practices support through our free cultural apps — ihi (te reo Māori) and Tala-Moana (Pacific languages).
• Accessible resources: Materials are available in multiple languages for practices to use with patients, we’ve co-designed initiatives with Māori and Pacific advisers from across communities, and we’ve attended community events to help raise health literacy.
• Inclusive engagement: We’ve helped our practices to reach out to non-enrolled individuals, recommend they extend clinical hours during promotional periods like cervical awareness month, and provided training to ensure whānau-centred care
• Trauma-informed practice: We’ve encouraged practices to acknowledge feelings of shame, allow space for kōrero, and welcome support people at appointments.
• Use funding streams wisely: We’ve guided practices to utilise funding streams to provide free screening, thereby addressing financial barriers that may be place for some patients.
• Partnered with Smear your Mea, a Māori health charity which promotes the importance of cervical cancer screening, and attended Te Matatini to raise awareness, promote advocacy and support through the detection, treatment, and prevention of cervical cancer for kaihaka (performers), whānau and hapori.
• Advocated to the Ministry of Health for the wider workforce to be able to provide this test, not just those who are authorised smear takers.
• Used Ara Hauora, our mobile health service, to deliver health education, have culturally safe kōrero, increase health literacy, and provide women with self-swabs in the privacy of their own home.

Let’s build on this momentum

We agree that women’s health deserves urgency and investment. As a nurse I’ve seen, and heard, first-hand from our practice teams that there are many barriers for wāhine to engage with cervical screening, for example cost, time, multiple conflicting priorities, alongside the invasiveness of the previous screening technique which the HPV self-testing now goes a long way to mitigate.

Gabrielle Lord is the Nursing Director and General Manager Clinical and Practice Services at ProCare. Photo / Supplied

However, it’s also important to recognise and celebrate what’s working. The HPV self-testing rollout is a significant step forward – and with continued focus on equity and access, we can accelerate progress even further, particularly when we ensure that HPV vaccination is an essential pillar of the overall approach to cervical cancer prevention.

Let’s not lose sight of the gains. Let’s build on them. As one of our practices told us recently: “Two years ago, our clinic was sitting at 58%. The self-testing has given our Māori and Pacific women the control and mana they needed. We have worked hard over the last couple of years to reach 70%. We still have a way to reach the 80% national target, and we even have aspirations of reaching 90%+! But we need to make it easier for women to access these tests – particularly Pasifika and Māori women who are disproportionately affected by cervical cancer.”

We dream of a future where all women are protected from this entirely preventable disease.

Gabrielle Lord is the nursing director and general manager clinical and practice services at ProCare.