Successful 869km 'Ride for Talei' amplifies cervical screening message among Māori communities

Months of planning, coordination and training has seen the 'Ride for Talei' crew successfully cycle the 869-kilometre journey Wellington to Auckland, in efforts to spread the important message of cervical screening across Māori communities.

The kaupapa, led by the Smear Your Mea Trust and led by Te Ururoa Flavell, departed from Waitangi Park, Wellington, on Tuesday, 14 February. 16 cyclists and 10 support crew carried the haerenga north, sharing the legacy left by Talei Morrison - a kapa haka extraordinaire who lost her battle to cervical cancer in 2018.

Before passing, Talei was a strong advocate of cervical cancer prevention through regular screening. The team traversed 8 days, 9 nights, 20 rohe visits, and 869 kilometres of road to tread as the roopu made their way north, carrying Talei’s mauri (spirit) north to the Te Matatini Pōwhiri on Tuesday, 21 February.

Free cervical screening was provided throughout the ride and at Te Matatini Kapa Haka Festival at Ngā Ana Wai – Eden Park by ProCare and Tāmaki Mākaurau providers.

A hugely successful and heartfelt reach to have so many wāhine and whānau be a part of the kaupapa whether directly through the ride or via the many events and clinics held in support across the mōtu. The kaupapa not only witnessed the cycle north, but also many efforts from organisations, gyms and whānau to host similar awareness-raising kaupapa to encourage wāhine Māori to screen.

The Smear Your Mea trust would like to extend a huge mihi to Te Whatu Ora for the support and also to the health providers across the nation for their support of this important kaupapa.

What’s happening in the NCSP

New NCSP Programme Manager Appointed

The National Cervical Screening Programme (NCSP) has a new Programme Manager – Anne Stewart (pictured). Anne replaces Nicki Martin who has stepped down after leading the Programme for the last 5 years.

Anne brings a skillset and expertise ideally suited to the needs of the Programme. She comes to us from the Ministry of Health where she was the Group Manager for the Office of the Chief Clinical Officers. Prior to this she was the National Lead for Laboratory Testing for COVID-19 for the Ministry, having been seconded in from Capital and Coast DHB. Anne held a number of senior roles at CCDHB including Operations Manager for blood and cancer, renal and palliative care, and General Manager Quality Improvement and Patient Safety.

Anne says she is looking forward to being involved with the Programme at a time when it is transitioning to HPV primary screening, and is very committed to the principles of Te Tiriti o Waitangi, namely tino rangatiratanga, equity, active protection, options and partnership.

“It is important that Te Tiriti principles are embedded throughout population-based screening programmes and are ingrained into the governance model. Equity is an essential priority in the rollout of HPV primary screening.

“It is an exciting time to join the programme. The foundations are being put in place for the transition to HPV testing and I know we have the support of the sector in making this happen.”

NCSP Advisory and Action Rōpū

The rōpū met on 23 February. Minutes of previous meetings can be found here.

Support to Screening Services web page

The web page for our SSS teams, supporting the work of both the National Cervical Screening Programme (NCSP) and BreastScreen Aotearoa (BSA) is available here.

Screening support services are available for eligible wāhine/whānau who are referred to, or who independently access services from the support to screening provider. This support can assist wāhine/whānau who experience barriers to accessing breast and cervical screening, assessment, and treatment services. Some support to screening providers have mobile teams who make community visits and home visits, while others are based in clinics around the motu.

Coverage app goes monthly

The NCSP coverage app has been updated and will now be updated monthly. Please note that the web location of the app has changed, and it now located here: https://tewhatuora.shinyapps.io/nsu-ncsp-coverage/

International HPV Awareness Day

International HPV Awareness Day (IHAD) is on 4 March.

IHAD is a key initiative of the International Papillomavirus Society (IPVS) which aims to increase public awareness of the virus as part of its mission to improve understanding of HPV and the importance of prevention, screening, diagnosis and treatment.

The campaign works from a belief that increasing public awareness and reducing the stigma of HPV is fundamental to the global effort to eliminate HPV and thereby to reduce the global cancer burden. By opening a conversation and providing people with the knowledge they need, the campaign aims to empower individuals and society to take effective action to reduce the harm caused by HPV.

This is a good opportunity for health services to promote the following key messages regarding the prevention of cervical cancer. For the NCSP, those key messages include:

  • From late July 2023 the primary test for cervical screening will change to a human papillomavirus (HPV) test
  • This new screening method will test for the presence of HPV, the cause of more than 95% of cervical cancers
  • The first line of defence against cervical cancer is prevention by safe, effective and proven HPV immunisation which is free for all people from ages 9 to 26 years old. The second line is maintaining regular cervical screening
  • HPV vaccination combined with screening provides the best protection from cervical cancer.

What’s happening with the HPV Primary Screening Project

The Road to Rollout HPV primary screening will begin to roll out in Aotearoa New Zealand in late July 2023 – just over four months from now.

It will bring new pathways that empower participants with choice; aims to increase participation in the most under-screened and unscreened populations and decrease barriers to entry for all participants. Enhanced health equity for wāhine Māori and Pacific women is being targeted through less-invasive clinical pathways combined with targeted outreach to the under-screened population.

We are looking to arrest a trend of declining cervical screening coverage for all participants that has persisted over the past eight years, with a greater decline for Māori and Pacific women. Boosting screening numbers will help align us to the World Health Organisation (WHO) global strategy to “eliminate cervical cancer as a public health problem, [by achieving] an incident rate of less than 4 in 100,000 women”. Te Whatu Ora has been making great progress through implementation of cervical screening to bring this down but more needs to be done to achieve the WHO goals and close the gap between different ethnic groups across NZ.

To that end, adopting HPV as a primary screening tool is predicted to result in a 19% reduction in cervical cancer mortality.

We can share with you some of the work that is going on behind the scenes to make this a reality, with the help of the sector. In order to support ramping up to roll out to late July 2023, the Project Team has been refined into working across seven workstreams to ensure we have all aspects covered and to bring together key areas in the development and delivery of HPV primary screening.

These workstreams are:

  • the creation of the new NCSP-Register
  • laboratories, colposcopy and primary care
  • change needs and training for the health sector
  • support needs (Support to Screening, clinical and system support)
  • data storage and monitoring
  • clinical and equity guidelines, including safety monitoring, and
  • campaigns and public-facing resources.

Several working groups have sector representation to assist us with advice and feedback on areas such as the new Register, laboratories transitioning to the new testing pathway, colposcopy, the needs of screen-takers and outreach.

The working groups have visibility over our commitment to equity and of the priority for Māori and Pacific. The design of the new programme is underpinned by our responsibility to Te Tiriti o Waitangi and ensuring equitable health outcomes for Māori. This was reinforced by feedback from organisations and individuals consulted around the new clinical pathway. Consultation also revealed there is strong support for Aotearoa New Zealand to move toward self-testing.

Three research projects are running HPV testing pilots and are feeding their findings back to the Project to inform our work. Similarly, the NCSP Advisory and Action Group, including sector representatives, provides further advice and feedback. Engagement with the sector is occurring through regular NCSP stakeholder hui (Kaimahi SSS, Regional Coordinators and Colposcopy), district cervical screening stakeholder networks, and primary care via presentations at screen-taker updates.

We are on the verge of sharing a lot more exciting information with you about the Road to Rollout. Keep an eye out for further details coming to you later in March.

Engagement with the Sector Increasing

The HPV Primary Screening Project Team are ramping up our engagement with sector groups to share the latest information on the Road to Rollout. We are starting to schedule attendance at regional screen-taker updates. The purpose of our presentations is to build screen-taker awareness, specifically on the changes, training and support for the transition to HPV primary screening.

We are currently working with regional coordinators in Southland, Hutt Valley, Tairāwhiti, Nelson/Marlborough, Taranaki and Waikato to get dates booked in. We will be attending more hui throughout the regions and will update you when these have been scheduled.

Regular engagement with sector organisations such as Family Planning, GPNZ and the New Zealand College of Midwives is also being planned.

Webinar and Resources

We have created a page on the NSU website with summaries of information from the Goodfellow Unit webinar held in September. The page can be found here and contains:

  • A PDF of Dr John McMenamin’s original presentation
  • A PDF of questions received from attendees, grouped into relevant sections, and answers provided by our clinical team
  • A PDF called Moving to HPV testing for primary cervical screening, which provides more detailed and expanded content than the original presentation, and which the sector can call on as a further resource.

About 1500 health professionals attended the webinar, where we addressed the twin themes of why it is important that people continue to screen between now and the transition to HPV primary screening in late July 2023, and the choices that will be available to participants, including self-testing.

A special shout out to the Te Toka Tumai Auckland and Waitematā Planning, Funding and Outcomes team who provided the webinar. The whole webinar is available to view on Goodfellow here: https://www.goodfellowunit.org/events-and-webinars/cervical-screening-update(link is external) which includes the popular presentations from the Te Toka Tumai Lead Colposcopist Dr Deralee Flower, and HPV self-testing research team at Te Toka Tumai and Waitematā Dr Karen Bartholomew and Nurse Specialist Jane Grant.

Other updates

Educational Video for Health Sector

Prior to Christmas we posted an online video for health sector professionals detailing the move to HPV primary screening. Based on feedback received, we’re in the process of slightly revising some wording for greater clarity. An update will be provided to let you know when the video is available.

This will be the first in a series of planned educational and learning tools to be made available in the run up to the transition to HPV testing in late July 2023. Keep an eye out for our updates as more resources become available.

Unit Standard Update

Toitū te Waiora with Te Whatu Ora are undertaking a review of Unit Standard 29556, Undertake Cervical Screening. Accreditation of nurses to support cytology procedures as part of follow up and surveillance will continue to be an important part of the new clinical pathway.

Public consultation was undertaken from 16 December to 23 January and subsequently the new standard has been endorsed by the HPV Primary Screening Project Steering Committee and will soon be submitted to NZQA. We will share the link to the standard when it is available.

Cervical screen-taker update

The NCSP and HPV Primary Screening Project team presented to a Cervical Screening Regional Coordination Stakeholders’ Hui (Canterbury and South Canterbury) in December. Questions and answers arising from that hui can be viewed here

https://www.nsu.govt.nz/system/files/page/screensouth_stakeholder_hui_qas_dec_2022_1.pdf

Clinical Practice Guidelines

The NCSP Clinical Practice Guidelines have been reviewed and are currently going through the editing process.

NCSP Policies and Standards

Work is progressing on updating the NCSP Laboratory and Colposcopy Policies and Standards, with feedback from the Working Groups collated and reviewed. They are going through the editing process before they can be published.

New HPV Primary Screening Resources

The NCSP has contracted the design agency Big River Creative to develop the public-facing resources for the new HPV primary screening programme. Big River Creative is a 100% Māori-owned, Māori and Pacific-led creative agency. It specialises in cultural graphic design and infographics to create mana-enhancing and culturally-responsive resources with a Te Tiriti o Waitangi focus that will resonate with priority audiences.

Laboratory Update

Signing of agreements concluded in December for the process to procure national laboratory services. The Labs RFP announcement is available on the NSU website at https://www.nsu.govt.nz/news/ncsp-hpv-primary-screening-labs-rfp-update

Immunisation Update

A campaign promoting the school immunisation programme (including HPV vaccinations) is now live in the market for six weeks from 13 February through until 26 March 2023 and will include TV OnDemand, online and search advertising.

For anyone looking to promote the HPV and Boostrix locally, the following resources are available here:

A newsletter insert and poster promoting the school immunisation programme for Years 7 and 8 (Te reo versions available)(link is external)

Informational videos

Immunisation leaflet available

An updated leaflet is available on HealthEd promoting HPV vaccinations. Entitled Immunise against HPV (human papillomavirus) – English version – HE2012 – HealthEd, it can be found here.

Answers to Your Questions

We are receiving regular feedback and questions to HPVscreen@health.govt.nz(link sends e-mail).

More information is available on the website here: Frequently asked questions | National Screening Unit (nsu.govt.nz).

Answers to Your Questions

We are receiving regular feedback and questions to hpvscreen@health.govt.nz(link sends e-mail).

More information is available on the website here: Frequently asked questions | National Screening Unit (nsu.govt.nz).

Answers to many clinical questions raised at the Goodfellow Unit webinar can be found in the link provided earlier in this newsletter.

Staying in touch

If you have colleagues who would also like to receive this monthly update, they can join the distribution list by emailing us at hpvscreen@health.govt.nz.

We really appreciate your feedback and are here to answer any questions you may have.