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1、Status Report:Cervical Cancer Elimination in the APEC RegionHealth Working GroupMarch 2023Status Report:Cervical Cancer Elimination in the APEC Region Measuring Progress Towards the APEC Roadmap to Promote Sustainable Economic Advancement for Women Through Cervical Cancer Prevention and Control 2021
2、-2025 2 Introduction and Table of Contents Cervical cancer is the fourth most common cancer among women worldwide,with an estimated 600,000 new cervical cancer cases and more than 340,000 estimated deaths in 2020 alone.However,cervical cancer presents an opportunity for prevention,screening,early de
3、tection,and treatment.By implementing interventions across the prevention and control continuum,APEC economies can reduce the disease burden and enable women to lead healthy and productive lives.Nevertheless,despite the compelling case for investing in strategies for cervical cancer prevention and c
4、ontrol,there remains insufficient investment,particularly in preventive measures.In 2016,the APEC Health Working Group(HWG)and Life Sciences Innovation Forum(LSIF)introduced a multi-year roadmap to scale efforts to build technical capacity and support policies that improve primary and secondary prev
5、ention,treatment,and palliative care,with the ultimate goal of cervical cancer elimination.In August 2021,APEC member economies endorsed an updated APEC Roadmap to Promote Sustainable Economic Advancement for Women through Cervical Cancer Prevention and Control(Roadmap)through 2025.The updated roadm
6、ap aligns with the WHOs Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem,which launched in November 2020 with targets set for 2030.Introduction Introduction to the Dashboard 2 Methodology 3 Regional Progress Towards the APEC Roadmap Meeting WHO Targets for
7、Cervical Cancer Elimination as a Public Health Problem 4 The Status of Cervical Cancer Elimination Planning in APEC 5 Programming and Funding Across the Cervical Cancer Prevention and Care Continuum 6 Introducing and Expanding HPV Vaccination 7 Advancing Cervical Cancer Screening 8 Progressing from
8、Diagnosis to Monitoring and Treatment 9 Tracking Uptake of the Prevention and Care Continuum 10 Introducing Communications Strategies to Reduce Disease Burden 11 Conclusion Key Findings 12 Summary and Limitations 13 Appendix 14 Sources 24 3 Methodology Status Report Overview The Status Report on Cer
9、vical Cancer Elimination in the APEC Region is an initiative to understand current status of the goals included within the APEC Roadmap,including implementation of comprehensive HPV vaccination,cervical screening,treatment,and elimination programs within APEC economies.The report aims to measure the
10、 progress of programs across the prevention and control continuum throughout the region.The report presents data on a regional basis,although economy-specific information has been collected and can be used to develop specific capacity-building activities.The report is organized by different HPV and
11、cervical cancer interventions,policies,and health system enablers.Each measure in the report is based on the goals and outputs/outcomes of the Roadmap.Spotlights from APEC economies share existing practices that can inform implementation and expansion of interventions and programs,and support progre
12、ss towards meeting the Roadmap goals more broadly.This project supports HWG 05 2022S,Promoting Sustainable Economic Advancement for Women by Addressing Policy Barriers to Prevention,Control,and Elimination of HPV and Cervical Cancer.Acknowledgements Methodology The report was created using a mixed m
13、ethodology to understand the current status of the Action Plans key indicators in the APEC region.The primary data source was a survey disseminated to all 21 APEC member economies via email.17 economies responded(81%)(“Reporting Economies”)between September 2022 and February 2023.The survey was then
14、 supplemented through a review of existing literature and data repositories,including WHO cervical cancer economy profiles and WHO/UNICEF Immunization Dashboard.Supplemental data was used both for reporting economies and non-reporting economies.Survey results were collected from the following APEC m
15、ember economies:Australia;Brunei Darussalam;Canada;Hong Kong,China;Indonesia;Japan;Republic of Korea;Malaysia;Mexico;Peru;the Philippines;the Russian Federation;Singapore;Chinese Taipei;Thailand;the United States of America;Viet Nam.Supplemental research was exclusively used for the following econom
16、ies:Chile;Peoples Republic of China;New Zealand;Papua New Guinea.Unless indicated,all measures are calculated using 21 as the denominator,counting missing data as no data.Additional methodology can be found in footnotes and the Appendix.This report was prepared by the project overseers partners.Prin
17、cipal authors include Ms.Alexa Trost and Ms.Anne Blatchford of C&M International.Special thanks to the project overseers,Dr.Suleeporn Sangrajrang of the Thailand National Cancer Institute and Dr.Edward Trimble of the United States National Cancer Institute,as well as to the APEC Secretariat for thei
18、r support.The views expressed in this paper are those of the authors and do not necessarily represent those of APEC Member Economies.4 33%10%24%52%57%19%Progress towards meeting 2030 targets1 by%of APEC economies%of complete dose HPV vaccine coverage,domestically eligible population or females2 2021
19、 or earlier years%of women screened for cervical cancer,by age3%of women identified with cervical cancer who received treatment4 2021 or earlier years 5%38%10%14%43%29%5%Under 35 Under 45 20-49 52%Last 5 Years,or earlier 52%Last 5 Years,or earlier 57%2019 No Data 90%No Data 70%-90%90%90%of girls ful
20、ly vaccinated with HPV vaccine by age 15 70%of women screened with a high-performance test by 35 years of age and again by 45 years of age 90%of women identified with cervical disease receive treatment Meeting WHO Targets for Cervical Cancer Elimination In August 2020,the WHO adopted the Global Stra
21、tegy for cervical cancer elimination by 2030,which is centered around three pillars and their corresponding targets.Achieving the WHO 90-70-90 targets by 2030 is estimated to avert more than 74 million new cases of cervical cancer and over 62 million deaths by 2120:No Data 70%1.Percentages are calcu
22、lated using 21 as the denominator,counting missing economies as no data.2.Survey responses on vaccination of domestically eligible populations are supplemented by WHO data on vaccination of females.3.Survey responses on screening(using any screening method)are supplemented by WHO data.Data for the U
23、nder 35 and Under 45 categories exclusively reflect survey responses.Data for the 20-49 category reflect WHO data,in addition to two survey responses.4.Survey data has not been supplemented.View data and limitations by economy on page 16.5 2 include HPV vaccination,3 include screening 3 All include
24、HPV vaccination,screening,and treatment 4 4 67%of APEC economies have in place a current multi-year plan that includes cervical cancer countermeasures:vaccination,screening,and/or treatment.24%have an outdated,undated,or in-progress plan.10 8 include HPV vaccination,all include screening Cervical Ca
25、ncer Elimination Plan Pan-Cancer Plan that includes Cervical Cancer NCD or Broader Health Plan that includes Cervical Cancer Plan in-progress or not available The Status of Cervical Cancer Elimination Planning in APEC A comprehensive cervical cancer elimination strategy requires multi-year commitmen
26、ts to the cervical cancer prevention and control continuum.Strategic planning for cervical cancer elimination should include considerations for health system capacity and infrastructure,including comprehensive information systems.#of APEC economies with current or outdated/undated multi-year plans t
27、hat include cervical cancer elimination1 1.View all plans on page 15.6 Programming and Funding Across the Cervical Cancer Prevention and Care Continuum Several economies do not report public funding for all cervical cancer interventions,even those reported to be included in domestic elimination prog
28、rams.Additionally,in the absence of a funded domestic cervical cancer elimination program,some economies report funding via domestic budgets or universal health coverage.%of APEC economies that report:67%1 of APEC economies report cervical cancer elimination programs,which introduce and/or provide f
29、unding for cervical cancer interventions to varying degrees.of APEC economies report including HPV vaccines in schedules or programs;3 of these economies,only 7 report funding for the entire domestically eligible population.4 of APEC economies report programs or capabilities for HPV/cervical cancer
30、screening,4 however,access to public funding may be dependent on factors such as diagnostic outcome and income level.of APEC economies report including treatment in domestic cervical cancer elimination programs;76%provide public funding,indicating that some economies provide treatment funding outsid
31、e of elimination programs.4 1.Survey data on public funding has not been supplemented.Percentages are calculated using 21 as the denominator,counting missing economies as no data.2.Economies measured as having public funding available for HPV vaccination include those which only provide public fundi
32、ng for some populations included in domestic immunization programs.3.Inclusion of HPV vaccines in domestic programs could include cervical cancer elimination programs,vaccine-specific programs,or partial programs that only cover certain jurisdictions or populations.4.Data on inclusion of vaccination
33、 and screening in cervical cancer elimination programs are supplemented by WHO data.Survey data on treatment has not been supplemented.Percentages are calculated using 21 as the denominator,counting missing economies as no data.View data and limitations by economy on pages 17 and 18.Approximate%of A
34、PEC economies which report funding for cervical cancer interventions in domestic elimination programs,budgets,or universal health coverage:1 Cervical Cancer Elimination 33%48%HPV Vaccination2 10%71%Screening 10%71%Treatment 19%5%76%No Data No public funding Public funding available 19%19%19%86%95%67
35、%7 Meeting WHO 2030 Vaccination Targets:Progress as of 2021 10%of APEC economies reached 90%first dose coverage for domestically eligible cohorts or girls in 2021.33%achieved rates between 70%and 90%.3 5%of APEC economies reached 90%complete dose coverage for domestically eligible cohorts or girls.2
36、4%have achieved rates above 70%,but below the 90%WHO target.3 Introducing and Expanding HPV Vaccination Since the approval of the first commercial HPV vaccine in 2006,71%of economies report including HPV vaccines in economy-wide immunization schedules or programs;in an additional 14%of economies,HPV
37、 vaccines are reported to be available in certain jurisdictions and/or only for private purchase.Vaccine-eligible populations vary across economies and include girls,boys,and adults,with the primary target cohort typically being young adolescent girls,aged 9-14.As of 2021,only one APEC economy reach
38、ed the WHO target of 90%2-dose vaccination coverage:1.Survey data has been supplemented with data from WHO for all populations.Data are only considered complete for inclusion of girls and boys.Percentages for all populations are calculated using 21 as the denominator,counting missing economies as no
39、 data.2.Some economies have removed catch-up or adult programs due to successful adolescent vaccination.3.Survey data has been supplemented with data collected by WHO on immunization coverage.Data are missing for both first dose coverage and complete dose coverage.Percentages are calculated using 21
40、 as the denominator,counting missing economies as no data.View data and limitations by economy on pages 16 and 19.Approximate%of APEC economies which report including HPV vaccination for certain populations in economy-wide immunization schedules or programs,2021-2023:1 Girls 14%14%71%Boys 76%24%Catc
41、h-up(15+)2 5%57%38%Adults(18+)2 5%71%5%19%No Data Not Included Available in Certain Jurisdictions or with Private Funds Included Economy-wide 8 86%57%19%of Economies reporting different types of screening available,2021-2023:3 Cervical Cytology(PAP Test)HPV DNA Testing Visual Inspection with Acetic
42、Acid(VIA)Advancing Cervical Cancer Screening If chronic HPV infection cannot be prevented and pre-cancerous lesions develop and are not diagnosed and treated in time,they have the potential to become an invasive cancer,decreasing the likelihood of survival if not recognized in early stages.Several t
43、ypes of screening are currently available in APEC economies,most commonly cervical cytology(also known as PAP tests)(86%),followed by HPV DNA testing(52%),and visual inspection with acetic acid(19%).As economies begin shifting screening programs to include HPV DNA testing the WHO preferred method as
44、 of 2021 at least 19%have introduced collection through self-sampling,which is increasingly viewed as a promising intervention due to its simplicity of delivery and the potential to reduce stigma.1 95%of APEC economies report domestic capabilities to conduct screening and diagnostic testing,however,
45、only 24%report screening 70%of at least one measured population:Under 35,Under 45,and/or Ages 20-49.2 *e.g.,National Population and Family Development Board,National Cancer Society of Malaysia,Ministry of Higher Education Hospitals 1.Survey data has not been supplemented.Percentages are calculated u
46、sing 21 as the denominator,counting missing economies or data as no data.2.Data on screening capabilities are supplemented with data from WHO and calculated using 21 as the denominator.Data are available for all economies.For screening coverage,measured populations include Under 35,Under 45,and 20-4
47、9.Survey responses on screening coverage(using any screening method)are supplemented by WHO data.3.Data on availability of screening interventions are supplemented with data from WHO;supplemental data only measures primary screening tests and may not be fully representative of the full range of inte
48、rventions available in each economy.Percentages are calculated using 21 as the denominator,counting potentially missing data(e.g.,availability of screening methods other than the primary method)as no data.View data and limitations by economy on pages 16 and 20.In Malaysia,HPV DNA testing,commenced i
49、n phases by the MOH in 2019 using a screen-triage-treat approach,is offered to women aged 30 to 65 years in primary care facilities in 13/15 states.Women who are HPV positive undergo cytology triage at primary care facilities prior to further intervention.The MOH is the primary provider for cervical
50、 cancer screening using cytology and HPV DNA tests;the MOH provides 65%of screening coverage while the remaining 35%is afforded by other agencies,private practitioners,and NGOs,*with whom the MOH collaborates to monitor cervical cancer screening data.This is vital as Malaysia is committed towards ac
51、hieving the targets for cervical cancer elimination.Additionally,the ROSE Foundation-a collaboration between University of Malaya and the Australian Centre for the Prevention of Cervical Cancer-offers HPV self-sampling to women in several primary care settings.9 Progressing from Diagnosis to Monitor
52、ing and Treatment Clearly defined clinical guidelines and referral systems from secondary to tertiary care following diagnosis of HPV or cervical disease underpin effective interventions across the continuum.1 62%report clinical guidelines for individuals who have been diagnosed with,or are at risk
53、of,HPV 76%report definitive strategies for referrals to secondary and tertiary care,including referral systems Multi-sector partnerships can provide economies with additional resources,capacity,and expertise to introduce tailored programs and improve access to services.The Philippines Department of
54、Health,for example,is collaborating with Jhpiego to find innovative improvements for the detection and prevention of Cervical Cancer through capacity building activities such as the introduction of innovative technologies,and creation of a woman-centered and more holistic approach to integrated serv
55、ices within the primary health care framework.33%report established programs linking individuals who have been diagnosed with,or are at risk of,HPV or cervical disease with prevention,treatment,and care resources 67%report standardized procedures for treatment follow-up 62%report domestic cervical c
56、ancer treatment facilities 1.With the exception of strategies for referral systems using WHO data,survey data has not been supplemented.Percentages are calculated using 21 as the denominator,counting missing economies as no data.View data and limitations by economy on page 21.10 Tracking Uptake of t
57、he Prevention and Care Continuum The APEC Roadmap calls for economies to build and/or integrate accessible and digital data systems and registries for vaccination,screening,cancer/treatment,and deaths in order to better track program impact and monitor changes in disease burden.Establishing and main
58、taining proficient and comprehensive information systems can support development of evidence-based policies and programs guided by the most recent surveillance data,research,and other evidence.Establishing and linking registries can support clinical and policy decision-making by providing a comprehe
59、nsive overview of access to cervical cancer interventions at the individual and population level.%of APEC economies reporting registries to track vaccination,screening,cancer/treatment,and deaths:Comprehensive,interoperable vaccination registries that enable providers to report administration and ac
60、cess all immunization records can support economies in accurately capturing and encouraging HPV vaccination.Screening registries and health data systems should be able to fully capture screening rates and support program implementation however,only 38%of economies have health data systems to track i
61、ndividuals through the health system after an abnormal screening test,and evaluate quality and timeliness of the screening program.3 Cancer registries can facilitate the systematic collection of data on cancer incidence,diagnosis,and treatment,in order to ensure patients receive appropriate and time
62、ly care.Data is also used by policymakers to make informed decisions on funding and program implementation.Establishing death registries to collect mortality data can be used to improve quality and safety of care,but data in registries is often incomplete or inaccessible to general practitioners.1.D
63、ata for vaccination,screening,death,and digital health data systems was limited to survey results.Percentages are calculated using 21 as the denominator,counting missing economies as no data.2.Survey data on existence of cancer registries are supplemented by WHO data,and is available for all 21 APEC
64、 economies.3.Data on existence of health data systems were not supplemented and are missing from 4 economies.Percentages are calculated using 21 as the denominator,counting missing economies as no data.View data and limitations by economy on page 22.62%Vaccination1 62%Screening1 86%Cancer2 71%Death1
65、 Australia is working to link domestic health registries through the National Cancer Screening Register(NCSR)to ensure a more comprehensive representation of the population within their health data system.This ensures that underreported groups-such as Indigenous communities are accounted for.11 Intr
66、oducing Communication and Delivery Strategies to Reduce Disease Burden Effective communications strategies and delivery systems should be evidence-based and targeted to eligible populations in order to bolster awareness and uptake of vaccines,screening,and treatment,as well as improve health equity.
67、Educational programs are most effective when they target all stakeholders involved in prevention and care including adolescents,parents,adults,and providers.57%of APEC economies report clinical HPV and cervical cancer educational programs targeted towards providers,which can support providers to opt
68、imize patient care.1 71%of economies report vaccine confidence or communications programs,either targeted towards adolescents/their parents.1 62%of economies report screening communications programs that are targeted towards eligible adults.1 62%of economies report requiring comprehensive sexual hea
69、lth educations in schools to provide adolescents with the knowledge and tools they need to promote their own health.1 71%of economies report school-based vaccination programs.2 1.Survey data has not been supplemented.Percentages are calculated using 21 as the denominator,counting missing economies o
70、r data as no data.2.Survey data has been supplemented with data collected by WHO on school-based vaccination.Percentages are calculated using 21 as the denominator,counting missing economies as no data.View data and limitations by economy on page 23.In 2012,Brunei Darussalam introduced a domestic sc
71、hool-based HPV vaccination program offering free or subsidized HPV vaccines to all female students ages 10-17 years old in both government and private schools.Parental or guardian consent is obtained in writing before the HPV vaccine is provided.In 2021,94.4%of the eligible Bruneian students was ful
72、ly vaccinated.The Public Health Agency of Canada(PHAC)Immunization Partnership Fund(IPF)funds over 100 diverse community-based initiatives to encourage vaccine confidence and uptake.An example of a project specific to HPV vaccine,in Quebec,Canada developed and evaluated parent-focused strategies,suc
73、h as motivational interviewing,education,decision-making tools,and consent form reminders to increase HPV vaccination coverage rates in select elementary schools.In Hong Kong,China,there is ongoing publicity by the government to raise public awareness and empower women in cervical cancer prevention
74、and screening,including dissemination of messages to correct common misconceptions which may keep some women from regular cervical screening-such as having no family history of cervical cancer,no symptoms,and having been vaccinated against HPV.Messages are disseminated via multiple channels,includin
75、g social media and other traditional means,such as TV and radio,websites,printed materials,published articles,media interviews,and telephone education hotlines.Relevant resources can be accessed at the thematic website of Cervical Screening Programme.Individual counselling is provided for women atte
76、nding Maternal and Child Health Centers and DOH Women Health Centers.12 Key Findings The results of Status Report:Cervical Cancer Elimination in the APEC Region indicate that while most economies have implemented some strategies for cervical cancer elimination,whether through a comprehensive cervica
77、l elimination program,ongoing development of a plan,or intervention strategies included in a broader cancer plan,there remain gaps in implementation.Of the 44 measures included in this report,reporting economies(n=17)met an average of 26 measures.1 Although APEC economies have made progress towards
78、the WHO 90-70-90 targets,none have reached all 3 targets for vaccination,screening,and treatment.2 48%2 of APEC economies meet one or more of the WHO 90-70-90 targets:5%2 of APEC economies administered 2 doses of HPV vaccine to 90%of girls,although 71%have introduced HPV vaccines into their economy-
79、wide schedules.To bolster vaccination rates,economies can develop targeted disease awareness strategies,introduce and increase routine vaccination of eligible populations,and build comprehensive vaccination registries to track progress.24%2 of APEC economies screened 70%of one or more age groups inc
80、luded in this analysis,3 despite 95%of economies measured as having domestic screening programs or capabilities to conduct screening and diagnostic testing.Introducing high-performance tests,providing public coverage for services,establishing referral strategies,and ensuring linkages to prevention,t
81、reatment,and care resources can support economies in preventing progression to cervical cancer by detecting abnormalities early.33%2 of APEC economies treated 90%of women identified with cervical cancer.Ensuring access to a global standard of care for treatment,symptom management,and palliative care
82、 can provide the best overall outcome for patients.Adopting preventive interventions can make treatment less intensive and costly.1.This calculation is based on economies for whom a definitive Yes was measured in responses to the survey and/or external research.Economies measured as ND may have addi
83、tional measures in place that are not captured in this report.2.Survey responses on vaccination of domestically eligible populations are supplemented by WHO data on vaccination of females.Survey responses on screening(using any screening method)are supplemented by WHO data.Survey data for treatment
84、has not been supplemented,and is based on survey data indicating that 7 reporting economies have treated 90%of women identified with cervical cancer.Percentages for all measures are calculated using 21 as the denominator,counting missing economies as no data.3.Data for the Under 35 and Under 45 cate
85、gories exclusively reflect survey responses.Data for the 20-49 category reflect WHO data,in addition to two survey responses.Of the WHO pillars,economies appear to be most successful in reaching targets for cervical cancer treatment.This reflects a traditional focus of health systems,but in order to
86、 reduce the disease incidence,increasing investment and uptake of vaccination and screening is an urgent imperative to prevent cervical cancer from occurring.13 Summary In order to achieve the goals of the APEC Roadmap to Promote Sustainable Economic Advancement for Women through Cervical Cancer Pre
87、vention by 2025,as well as to support the vision and mission(right),economies should plan to invest in holistic strategies across the prevention and care continuum.Continuing to strengthen data systems,introduce countermeasures,and develop communication and delivery strategies will support the healt
88、h and well-being of women during the years of peak productivity and contribution to society,as well as the years in which many women attain leadership positions and raise families.This status report aims to support economies in their domestic and collective efforts to introduce comprehensive cervica
89、l cancer elimination plans,implement the APEC Cervical Cancer Roadmap,and collaborate to enhance elimination programs by sharing best practices.APEC economies can also support progress towards cervical cancer elimination through use of other APEC resources,such as the APEC Healthcare Financing Roadm
90、ap and the Health Working Groups Best Practices and Recommendations for APEC Collaboration on Cancer Control.Limitations *Vaccine-eligible populations may include girls,boys,and adults at-risk for HPV infection The research conducted in this study has some limitations.The primary limitation was rece
91、iving responses to the survey from only 17 of 21 APEC economies;given limited aggregated external data options for many measures and economies,results do not reflect the full status of the measured cervical cancer elimination strategies within the APEC region and individual economies.Data caveats ha
92、ve been added throughout the report to indicate where supplemental data is unavailable.Second,the report measured the extent to which measures have been introduced.Within each measure,the authors expect differences in scope(e.g.,eligible populations,funding levels,jurisdictional vs.economy-wide)and
93、status of implementation(e.g.,pilot projects vs.ongoing legislation,newly introduced measures prehensive long-term programs)across APEC economies.Mission To foster exchange of best practices,build technical capacity,and support policy decision-making to address barriers to primary and secondary prev
94、ention of cervical cancer and invasive cervical cancer treatment and palliative care.Vision 2025 Women and girls in APEC member economies live healthy and productive lives,with a substantially reduced burden of HPV-related cervical cancer morbidity and mortality.Goals The Roadmap aims to support eff
95、orts by APEC member economies to eliminate cervical cancer as a public health problem and to:1.Accelerate and scale primary prevention of cervical cancer through HPV vaccination of eligible populations*2.Accelerate and scale secondary prevention of cervical cancer through effective screening and tre
96、atment of precancerous lesions 3.Expand the application of health-systems tools,including communications technologies and electronic health records management systems,to improve the quality of treatment and palliative care for people with HPV and cervical cancer 4.Improve infrastructure to support a
97、cceleration and scaling of primary prevention,secondary prevention,treatment,and palliative care 14 APPENDIX|Acronyms APEC:Asia-Pacific Economic Cooperation DIP:Domestic Immunization Program DNA:Deoxyribonucleic acid HPV:Human papillomavirus HWG:Health Working Group IPF:Immunization Partnership Fund
98、 Jhpiego:Johns Hopkins Program for International Education in Gynecology and Obstetrics KPI:Key performance indicator LSIF:Life Sciences Innovation Forum MOH:Ministry of Health NCSR:National Cancer Screening Registry PHAC:The Public Health Agency of Canada ROSE:Removing Obstacles to Cervical Screeni
99、ng UNICEF:United Nations Childrens Fund VIA:Visual inspection with acetic acid WHO:World Health Organization 15 APPENDIX|Data by APEC Economy Cervical Cancer Elimination Plans or Regulations Canada:Action Plan 2020-2030 Indonesia:Regulations 2015,amended 2017(NCD/Health Strategic Actions)Malaysia:Ac
100、tion Plan 2021-2030(Pan-Cancer Plan 2021-2025)Peru:Plan 2017-2021(Pan-Cancer Plan 2020-2024)Pan-Cancer Plans that include Cervical Cancer Chile:Plan 2018-2028 Hong Kong,China:Strategy 2019-2025 Japan:Plan Republic of Korea:Plan 2016-2020 Mexico:Program(2016)New Zealand:Action Plan 2019-2029 Papua Ne
101、w Guinea:Action Priorities 2017-2021 Russian Federation:Plan 2019-2024 Chinese Taipei:Plan Thailand:Program Non-Communicable Disease(NCD)or Broader Health Plans that include Cervical Cancer Brunei Darussalam:NCD Action Plan 2021-2025 Peoples Republic of China:Health Initiative 2019-2030 The United S
102、tates:Health Plan 2020-2030;64 plans from states,jurisdictions,tribes/tribal organizations,and the Cancer Council of the Pacific Islands Viet Nam NCD Strategy Plan in-progress or not available Australia:Cervical Cancer Strategy development in progress;expected April 2023(Draft;Draft Appendices);10-y
103、ear pan-cancer plan development in progress,expected April 2023 The Philippines:Cancer Control plan in drafting process Singapore:N/A Multi-year plans that include references to HPV and/or cervical cancer 16 APPENDIX|Data by APEC Economy Meeting WHO Targets for Cervical Cancer Elimination Measure Co
104、verage rates reported for 2021 or earlier years Australia*Brunei Darussalam*Canada*Chile Peoples Republic of China Hong Kong,China*Indonesia*Japan*Republic of Korea*Malaysia*Mexico*New Zealand Papua New Guinea Peru*Philippines*Russian Federation*Singapore*Chinese Taipei*Thailand*United States of Ame
105、rica*Viet Nam*Total%first dose HPV vaccination(domestic cohort)1 87%98%ND ND 88%3 80%3.3%88%16%6 10%ND 4%7 ND 90%9 85%0%77%ND 2 HPV Vaccination program coverage,first dose,females2 87%67%ND 68%ND ND%complete dose HPV vaccination(domestic cohort)1 81%95%ND ND 86%3 61%1.9%66%14%6 10%ND 1%7 ND 88%9 76%
106、0%62%ND 1 HPV Vaccination program coverage,last dose,females2 87%57%ND 58%ND 53%ND%of women screened in last five years,or earlier1 35 62%25%ND 29%3 15%-49%5 44%42-48%30%20%ND 31%9 64%70%ND 15%1 45 67%28%ND 38%3 15%-56%5 52%29-30%50%30%70 ND 10-50 ND 70 ND 10-50 ND 50-70 50-70 ND 50-70 7010 10-50 3%
107、of women with cervical cancer treated1 94%100%ND 91%3 ND ND ND 90%ND ND 100%76%89.8%9 90%95%ND ND 7*Submitted survey responses 1.Source:Survey of APEC Economies.All decimals have been rounded to the nearest whole number.2.Source:WHO/UNICEF Joint Reporting Form on Immunization.Human Papillomavirus(HP
108、V)vaccination coverage.All decimals have been rounded to the nearest whole number.3.In Hong Kong,China,in school year 2020-2021 first dose HPV vaccination was measured in primary five female students and complete dose HPV vaccination was measured in primary six female students.For screening,based on
109、 the Health Behaviour Survey 2018/19,a local survey covering the land-based non-institutional female population:29.0%of women aged 25-34 and 37.5%of women aged 25-44 were screened in 2018/19.For treatment,91.4%of patients with cervical cancer had received surgery,radiotherapy or chemotherapy(or a co
110、mbination).4.According to the Indonesia survey response,9.35%of woman aged 30-50 years old were screened in the last three years,2020-2022 5.In Japan,according to the interview-based survey conducted every three years,the latest participation rates across 5-year age groups in 2019 are as follows:15.
111、1 of 2025 year-olds,36.6 of 2530 year-olds,49.4 of 3035 year-olds,53.0 of 3540 year-olds,56.1 of 4045 year-olds.6.In Malaysia,there was no HPV vaccine supply in 2021 due to global shortages,hence the low coverage.The average HPV vaccination coverage before 2021 has been consistently more than 95%.7.
112、In the Philippines,out of 1,036,009 target population,43,960 received the first dose of HPV vaccine in 2021.Out of 1,036,009 target population,3,519 completed the HPV vaccine in 2021.Currently Philippine data aggregates women screened for cervical cancer age 20 y/o and above.2021-74,900 women screen
113、ed out of 33,455,399 eligible population;2020-40,420 women screened out of 32,789,368 eligible population;2019-224,620 women screened out of 31,508,155 eligible population 8.Source:WHO.Maternal,Newborn,Child and Adolescent Health and Ageing Data portal.9.According to the Singapore survey response,90
114、%of the 15-year-old cohort had received 1 and 2 doses of HPV vaccine under the school-based vaccination programme in 2021;87%of 15-year-olds in the resident population,which is similar but not identical to the school-based programme,had received 2 doses.30.5%of women aged 18-35 years and 42.7%of wom
115、en aged 18-45 years reported screening.The National Population Health Survey captures self-reported data for women screened at appropriate intervals for cervical cancer(last 5 years for HPV testing,and last 3 years for pap smear).Treatment coverage reflects women who were diagnosed in 2020 and recei
116、ved treatment thereafter;data on treatment is limited to up to 6 months post-diagnosis.10.According to the United States survey response,80%of women between the ages of 21-65 years have been screened within the last 3 years.17 APPENDIX|Data by APEC Economy Programming and Funding Across the Cervical
117、 Cancer Prevention and Care Continuum(1/2)Measure Australia*Brunei Darussalam*Canada*Chile Peoples Republic of China Hong Kong,China*Indonesia*Japan*Republic of Korea*Malaysia*Mexico*New Zealand Papua New Guinea Peru*Philippines*Russian Federation*Singapore*Chinese Taipei*Thailand*United States of A
118、merica*Viet Nam*Total Yes%of APEC economies with interventions available through cervical cancer elimination or intervention-specific programs Domestic cervical cancer elimination program1 Yes Yes Yes ND ND No Yes No Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes Yes No 14 HPV Vaccination1 Yes Yes Yes Ye
119、s3 Yes4 No Yes Yes Yes Yes Yes5 No Yes Yes Yes Yes No 18 HPV included in vaccination programme or schedule2 Yes No Yes2a Yes No R2a,6 Screening1 Yes Yes Yes Yes3 Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No 20 Screening programme for cervical cancer exists2 Yes Yes Yes2a Yes2a Yes No Yes2a Treat
120、ment1 Yes Yes Yes Yes3 Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No 14*Submitted survey responses R:Restricted to private purchase 1.Source:Survey of APEC Economies.Economies measured as Yes assume HPV vaccines are available for girls,at minimum.More detailed data can be found in page 19.2.Sourc
121、e:WHO/UNICEF data on Vaccination schedule for Human papilloma virus and WHO Cervical Cancer Economy Profiles were used for economies which did not submit survey responses.a.This data was also used for Japan,Republic of Korea,and Viet Nam,which,for example,may not report interventions in broader cerv
122、ical cancer elimination programs as is asked in the survey,but instead have standalone programs(e.g.,screening programs or HPV in immunization programs)as is measured in the WHO Profiles.3.Although there is no cervical cancer elimination program in Hong Kong-China,HPV vaccination,screening,and treat
123、ment are in place 4.In Indonesia,the introduction of HPV immunization has been carried out in stages:in 2021 20 districts had implemented HPV immunization,in 2022 132 districts had implemented HPV immunization,and in 2023 HPV immunization will be expanded domestically.5.According to WHO/UNICEF data
124、on Vaccination schedule for Human papilloma virus in the Philippines,the HPV vaccine is administered to girls in certain regions.6.In Viet Nam,the Ministry of Health has licensed the use of HPV vaccines for ages 9-26,but the vaccine is only available for private purchase at this time.Viet Nam plans
125、to include HPV vaccines in the Expanded Program on Immunization(EPI)by 2026.18 APPENDIX|Data by APEC Economy Programming and Funding Across the Cervical Cancer Prevention and Care Continuum(2/2)Measure Australia*Brunei Darussalam*Canada*Chile Peoples Republic of China Hong Kong,China*Indonesia*Japan
126、*Republic of Korea*Malaysia*Mexico*New Zealand Papua New Guinea Peru*Philippines*Russian Federation*Singapore*Chinese Taipei*Thailand*United States of America*Viet Nam*Total Yes%of APEC economies with publicly funded coverage available through domestic cervical cancer elimination program,domestic bu
127、dget,or universal health coverage,by intervention1 Cervical cancer elimination Yes Yes Yes ND ND No Yes No No Yes No ND ND Yes No No Yes Yes Yes Yes No 10 HPV vaccination for all populations included in the domestic immunization program Yes Yes ND ND ND No No Yes No Yes No ND ND Yes No No No No Yes
128、Yes No 7 HPV vaccination for some populations included in the domestic immunization program Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes ND ND Yes Yes No Yes Yes Yes Yes No 15 Cervical cancer screening Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes Yes No 16 Treatment of invasi
129、ve cervical cancer Yes Yes Yes ND ND Yes Yes Yes No Yes Yes ND ND Yes Yes Yes Yes Yes Yes Yes Yes 16*Submitted survey responses 1.Data was limited to survey results.Percentages in the report are calculated using 21 as the denominator,counting missing economies or data as no data.19 APPENDIX|Data by
130、APEC Economy Introducing and Expanding HPV Vaccination Measure Australia*Brunei Darussalam*Canada*Chile Peoples Republic of China Hong Kong,China*Indonesia*Japan*Republic of Korea*Malaysia*Mexico*New Zealand Papua New Guinea Peru*Philippines*Russian Federation*Singapore*Chinese Taipei*Thailand*Unite
131、d States of America*Viet Nam*Total Yes Approximate%of APEC economies which include HPV vaccination for certain populations in immunization schedules or programs Girls1 Yes Yes Yes3 Yes No Yes Yes4 Yes Yes Yes Yes Yes No Yes Yes5 No6 Yes7 Yes Yes Yes Yes(R)8 18 Boys2 Yes No Yes Yes No No No No No No
132、No Yes No No No No No No No Yes No 5 Catch-up(15+)2 Yes Yes Yes ND No No No Yes No No No Yes No Yes No No Yes No Yes No No 8 Adults(18+)2 Yes No Yes ND No No No No No No No Yes No No No No Yes No No No Yes(R)8 5*Submitted survey responses R:Restricted to private purchase 1.Source:WHO Cervical Cancer
133、 Economy Profiles:WHO Economy Profiles were used to measure whether Domestic Immunization Programs(DIP)include HPV vaccines for girls in Chile,China,New Zealand,and Papua New Guinea.This data measures if HPV is included in the DIP.2.Source:WHO/UNICEF data on Vaccination Schedule for Human papilloma
134、virus was used to measure whether DIPs include HPV for males in Chile,China,New Zealand,and Papua New Guinea.The report was also used to measure inclusion of populations 15+and 18+in New Zealand.3.In Canada,HPV vaccination is under the jurisdiction of Provincial and Territorial governments,so progra
135、ms vary across regions.HPV vaccination programs in Canada include all genders and all jurisdictions now have HPV immunization catch-up programs.4.In Indonesia,HPV vaccines are administered to elementary school girls ages 11-12.The introduction of HPV immunization has been carried out in stages:in 20
136、21 20 districts had implemented HPV immunization,in 2022 132 districts had implemented HPV immunization,and in 2023 HPV immunization will be expanded domestically.5.According to WHO/UNICEF data on Vaccination schedule for Human papilloma virus in the Philippines,the HPV vaccine is administered to gi
137、rls in certain regions.6.In the Russian Federation,HPV vaccines are not included in the immunization program,however,17 regions conduct HPV vaccination of girls ages 12-14.7.In Singapore,HPV vaccination is recommended for all females ages 9 to 26 years,under the National Childhood Immunisation Sched
138、ule(NCIS)and National Adult Immunisation Schedule(NAIS).8.In Viet Nam,the Ministry of Health has licensed the use of HPV vaccines for ages 9-26,but the vaccine is only available for private purchase at this time.Viet Nam plans to include HPV vaccines in the Expanded Program on Immunization(EPI)by 20
139、26.20 APPENDIX|Data by APEC Economy Advancing Cervical Cancer Screening Measure Australia*Brunei Darussalam*Canada*Chile Peoples Republic of China Hong Kong,China*Indonesia*Japan*Republic of Korea*Malaysia*Mexico*New Zealand Papua New Guinea Peru*Philippines*Russian Federation*Singapore*Chinese Taip
140、ei*Thailand*United States of America*Viet Nam*Total Yes Does your economy have:Domestic capabilities to conduct screening and diagnostic testing1 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes 20 What type of screenings for cervical cancer are available in your ec
141、onomy?HPV DNA test2 Yes No Yes Yes3 Yes No4 No No Yes Yes Yes No No Yes Yes Yes Yes Yes 12 Pap test2 No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 18 Visual Inspection with Acetic Acid(VIA)2 No No No No Yes No No No No Yes Yes No No No No Yes 4 Self-sampling2 Yes No N
142、o Yes No No No Yes No Yes No No No No No No 4*Submitted survey responses 1.Source:WHO Cervical Cancer Economy Profiles were used to measure whether domestic screening programs exist in Chile,China,New Zealand,and Papua New Guinea.2.WHO Cervical Cancer Economy Profiles were used to measure primary sc
143、reening tests used in Chile,China,and New Zealand.The profiles do not measure all types of screening available in these economies.3.Source:HPV Information Center.Human Papillomavirus and Related Diseases Report,Chile 4.Indonesia has plans to conduct a pilot project to introduce HPV DNA testing in re
144、stricted populations.21 APPENDIX|Data by APEC Economy Progressing from Diagnosis to Monitoring and Treatment Measure Australia*Brunei Darussalam*Canada*Chile Peoples Republic of China Hong Kong,China*Indonesia*Japan*Republic of Korea*Malaysia*Mexico*New Zealand Papua New Guinea Peru*Philippines*Russ
145、ian Federation*Singapore*Chinese Taipei*Thailand*United States of America*Viet Nam*Total Yes Clinical guidelines for individuals who have been diagnosed with,or are at risk of,HPV Yes No Yes ND ND Yes Yes No Yes Yes Yes ND ND No No Yes Yes Yes Yes Yes Yes 12 Definitive strategies for referrals to se
146、condary and tertiary care1 Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes No No Yes No Yes Yes Yes Yes 16 Established programs linking individuals who have been diagnosed with,or are at risk of,HPV with prevention,treatment,and care resources Yes No Yes ND ND No Yes No No No No ND ND No Yes Yes N
147、o Yes No Yes No 6 Standardized procedures for treatment follow-up Yes Yes Yes ND ND Yes Yes No ND Yes Yes ND ND No Yes Yes Yes Yes Yes Yes Yes 13 Domestic cervical cancer treatment facilities Yes Yes Yes ND ND No Yes Yes ND Yes Yes ND ND No Yes Yes Yes Yes No Yes Yes 12*Submitted survey responses 1.
148、Source:WHO Cervical Cancer Economy Profiles were used to measure whether clearly defined referral systems exist from primary care to secondary and tertiary care in Chile,China,New Zealand,and Papua New Guinea.Although the profiles indicated that such systems exist in Japan,Republic of Korea,Peru,the
149、 Philippines,and Singapore,survey responses were given preference.22 APPENDIX|Data by APEC Economy Tracking Uptake of the Prevention and Control Continuum Measure Australia*Brunei Darussalam*Canada*Chile Peoples Republic of China Hong Kong,China*Indonesia*Japan*Republic of Korea*Malaysia*Mexico*New
150、Zealand Papua New Guinea Peru*Philippines*Russian Federation*Singapore*Chinese Taipei*Thailand*United States of America*Viet Nam*Total Yes Vaccination registries1 Yes Yes No ND ND No Yes Yes Yes Yes No ND ND Yes Yes Yes Yes Yes Yes No Yes 13 Screening registries1 Yes Yes Yes ND ND Yes Yes No No Yes
151、Yes ND ND Yes Yes Yes Yes Yes Yes No No 13 Cancer registries2 Yes Yes Yes Yes Yes Yes Yes Yes No Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes 18 Death registries1 Yes Yes Yes ND ND Yes No No Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes Yes Yes 15 Digital health data systems Yes Yes Yes ND ND Yes Yes N
152、o Yes Yes No ND ND Yes No Yes Yes Yes Yes Yes No 13 Health data systems to track individual women through health system after abnormal screening tests and evaluate quality and timeliness of the screening program Yes Yes No ND ND Yes No No No No No ND ND No No Yes Yes Yes Yes Yes No 8 Does your econo
153、my have:3 Screening registries to identify women eligible for screening Yes Yes No ND ND No Yes No Yes No No ND ND No Yes Yes Yes Yes Yes No No 8 Screening registries that can track womens history of screening Yes Yes No ND ND Yes Yes No Yes No No ND ND No No Yes Yes Yes Yes No No 8*Submitted survey
154、 responses 1.Data for vaccination,screening,death,and digital health data systems was limited to survey results.Percentages in the report are calculated using 21 as the denominator,counting missing economies or data as no data.2.Source:WHO Cervical Cancer Economy Profiles were used to measure whethe
155、r population-based cancer registries exist in Chile,China,New Zealand,and Papua New Guinea.3.This data was measured using the survey and is not explicitly included in the KPI report,but is included in the appendix for reference.23 APPENDIX|Data by APEC Economy Introducing Communication and Delivery
156、Strategies to Reduce Disease Burden Measure Australia*Brunei Darussalam*Canada*Chile Peoples Republic of China Hong Kong,China*Indonesia*Japan*Republic of Korea*Malaysia*Mexico*New Zealand Papua New Guinea Peru*Philippines*Russian Federation*Singapore*Chinese Taipei*Thailand*United States of America
157、*Viet Nam*Total Yes Clinical HPV and cervical cancer educational programs targeted towards providers1 Yes No Yes ND ND Yes Yes No ND Yes No ND ND No Yes Yes Yes Yes Yes Yes Yes 12 Vaccine confidence communications programs targeted towards adolescents and/or their parents1 Yes Yes Yes ND ND Yes Yes
158、Yes Yes Yes Yes ND ND No Yes Yes Yes Yes Yes Yes No 15 Screening communications programs targeted towards eligible adults1 Yes No Yes ND ND Yes Yes No No Yes Yes ND ND No Yes Yes Yes Yes Yes Yes Yes 13 Comprehensive sexual health education required in schools1 Yes No Yes4 ND ND Yes Yes Yes ND Yes No
159、 ND ND Yes Yes ND Yes Yes Yes Yes2 Yes 13 School-based vaccination programs,that include HPV vaccination,for domestically eligible populations 1,3 Yes Yes Yes Yes No Yes Yes No Yes Yes Yes Yes No Yes Yes No Yes Yes Yes No No 15*Submitted survey responses1.Source:Survey of APEC Economies2.Only some j
160、urisdictions require comprehensive sexual health education in the United States.3.Survey responses were prioritized for most economies.WHO/UNICEF data on Routine Vaccines Delivered at School was used to measure whether HPV vaccines are administered in schools in Chile,China,New Zealand,and Papua New
161、 Guinea.School-based programs were not defined in the survey and may include pilot programs and educational programs.4.In Canada,most Provinces and Territories require sexual health education be included in elementary school curriculums,though ages at which topics are introduced vary amongst jurisdi
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