Cervical Cancer Prevention Through HPV Vaccination in Low- and Middle-Income Countries in Asia

Cervical cancer is ranked the first or second most common cancer in women of low- and middle-income countries (LMICs) in Asia. Cervical cancer is almost exclusively caused by human papillomavirus (HPV), and majority of the cases can be prevented with the use of HPV vaccines. The HPV vaccines have demonstrated high vaccine efficacies against HPV infection and cervical cancer precursors in clinical and post-marketing studies, and are in use in most high-income countries. However, their use in LMICs are limited mainly due to the high costs and logistics in delivering multiple doses of the vaccine. Other issues such as the safety of the vaccines, social and cultural factors, as well as poor knowledge and awareness of the virus have also contributed to the low uptake of the vaccine. This mini-review focuses on the need for HPV vaccine implementation in Asia given the substantial disease burden and underuse of HPV vaccines in LMICs in this region. In addition, the progress towards HPV vaccine introduction, and barriers preventing further rollout of these essential, life-saving vaccines are also discussed in this article

The impact of a 2018 tax increase on illicit cigarette trade in Mongolia - baseline results

Background and challenges to implementation Mongolia battles with high smoking prevalence - 49% of adult male and 5.3% of adult female smoked in 2013. An evidence based tobacco tax policy could substantially reduce this prevalence. A study found that a 9-fold increase in tobacco tax could help Mongolia to reach its Sustainable Development Goals target of 30% prevalence reduction by 2025. Despite a lot of opposition to a tobacco tax increase citing a possible increase in illicit trade, the government of Mongolia increased tobacco excise tax by 10% effective Jan 1, 2018. This tax increase is insufficient to have a meaningful impact on the prevalence. Intervention or response We designed a study to measure the impact of the tax increase on any change in the size of illicit cigarette trade. It is based on collecting discarded cigarettes packs on the streets of Ulaanbaatar and another two provinces bordering Russia and China in three waves- April 2017, April 2018 and October 2018. We are recording the packs´ features, such as the presence of a Mongolian tax stamp, the correct graphic and text health warnings, and the presence of duty-free signs. This method will identify any changes in illegal tax evasion and legal tax avoidance, both representing tax losses for the governments. Results and lessons learnt We have collected the total of 7000 discarded packs in April 2017. We will present the results of this first wave of data collection in terms of share of packs that did not pay taxes in Mongolia. Conclusions and key recommendations We will also show the share of packs with special promotional features such as "Super Slim" or "Less Smoke Odour", and analyse the share of packs with different pictorial health warnings since the companies are aware that certain pictures are more unpleasant compared to others

Formative research to inform information, education and communication materials ahead of HPV vaccine re-introduction in Mongolia

Abstract:  The 2012 HPV vaccination pilot in Mongolia was met with widespread community resistance and misinformation. Targeted stakeholder action since 2012 has led to a decision to re-introduce the HPV vaccine from 2020. This formative research study is the first to identify information and communication needs among key population groups in Mongolia ahead of vaccine re-introduction. This qualitative study was conducted across five provinces and two capital city districts of Mongolia. Small focus group discussions and individual in-depth interviews were held with GP doctors, school doctors, immunization nurses and teachers and parents of girls aged 10–13 years. The study recruited 91 parents, 62 teachers and 47 health professionals. Knowledge varied between and within study populations. Overall, participants demonstrated positive attitudes and practices towards vaccination generally. Knowledge surrounding the HPV vaccine specifically was very low across all population groups, with negative attitudes linked to previous misinformation. Health professionals identified a need for a unified information source on vaccination and greater technical training. The study highlights a clear need for increased awareness raising on HPV, cervical cancer and the HPV vaccine in order to avoid another communication crisis in the 2020 vaccine re-introduction

Barriers to the early integration of palliative care in pediatric oncology in 11 Eurasian countries

BACKGROUND: The early integration of palliative care significantly improves quality of life for children with cancer. However, cultural, structural, and socioeconomic barriers can delay the integration of palliative care into cancer care, particularly in low-income and middle-income countries. To date, little is known regarding the timing of and barriers to palliative care integration in Eurasia. METHODS: The Assessing Doctors\u27 Attitudes on Palliative Treatment (ADAPT) survey evaluates physician perceptions regarding palliative care integration into pediatric oncology in Eurasia. This evidence-based survey was adapted to the regional context; iteratively reviewed by US and regional panelists; and piloted in English, Russian, and Mongolian. After distribution to physicians caring for children with cancer, statistical analysis was complemented by qualitative analysis of open-ended responses. RESULTS: A total of 424 physician responses were received from 11 countries in the Eurasian region. Study findings demonstrated wide variability in access to palliative care experts across countries (18%-96%), with the majority of providers (64%) reporting that the initial palliative care consultation typically occurs when curative options are no longer available. Providers desired an earlier initial palliative care consultation than what currently occurs in their setting (P \u3c .001). Primary barriers to timely consultation included limited access to palliative care services and specialists, lack of physician education, and perceived family resistance. CONCLUSIONS: The current study is the first to identify physician perceptions of the delayed timing of palliative care integration into childhood cancer care and associated barriers in Eurasia. These findings will inform the development of targeted interventions to mitigate local structural and cultural barriers to access and facilitate earlier palliative care integration in the region

Translating Research to Action: The Development of a Pediatric Palliative Cancer Care Advocacy Tool in Eurasia

PURPOSE: The Assessing Doctors\u27 Attitudes on Palliative Treatment study was conducted in 11 Eurasian countries to assess physician knowledge of and structural barriers to integration of palliative care into pediatric oncology. After publication, regional collaborators identified the need to disseminate country-specific study results locally and provide policy recommendations to inform stakeholders. METHODS: The Assessing Doctors\u27 Attitudes on Palliative Treatment report was developed with Eurasian and St Jude pediatric palliative care and oncology experts to summarize study findings and deliver country-level data to local stakeholders. In parallel, an assessment was developed to explore how regional collaborators intend to use the report to improve local advocacy and dissemination of research findings. The country report and assessment were translated to English, Russian, and Mongolian. RESULTS: Country-specific two-page reports display study findings on pediatric palliative care education, access to pediatric palliative care services, and barriers to and timing of integration with cancer care, alongside clinical and policy recommendations. These reports were distributed to collaborators in 11 countries. Assessment results (N = 30) demonstrated that regional collaborators planned to distribute the report to institutional and government stakeholders, aiming to increase access to pediatric palliative care services (77%), establish a community-based palliative care network (70%), and increase opportunities for specialization (70%). CONCLUSION: We describe the development of an evidence-based advocacy tool to inform local health and education policy in Eurasia. This summary report of study findings, translated to local languages and adapted to a broader audience, is currently used to advocate for greater access and quality of palliative care for children with cancer. This work may serve as the basis for future dissemination efforts of scientific research

A multicountry assessment in Eurasia: Alignment of physician perspectives on palliative care integration in pediatric oncology with World Health Organization guidelines

BACKGROUND: The World Health Organization (WHO) advocates for early integration of palliative care for all children with life-threatening illness. Provider awareness and misperceptions, however, can impede this imperative. In the Eurasian region, little is known about physician knowledge and perspectives on palliative care. METHODS: The Assessing Doctors\u27 Attitudes on Palliative Treatment survey was developed as an evidence-based and culturally relevant assessment of physician perceptions on palliative care integration into childhood cancer care in Eurasia. Iteratively tested by American and Eurasian palliative care experts, the survey was culturally adapted, translated, and piloted in English, Russian, and Mongolian. The survey was distributed to physicians caring for children with cancer. Fifteen statements were scored in accordance with WHO guidelines to evaluate provider knowledge. The statistical analysis was complemented by a qualitative analysis of open-ended responses. RESULTS: This study received 424 responses from 11 countries in Eurasia. The mean alignment between provider perspectives and WHO recommendations was 70% (range, 7%-100%). Significant independent predictors of higher alignment included country, prior palliative care education, and greater experience with patient death. Respondents primarily described palliative care as end-of-life care and symptom management. Two-thirds of respondents (67%) reported not feeling confident about delivering at least 1 component of palliative care. CONCLUSIONS: This is the first study assessing physician perspectives and knowledge of palliative care in Eurasia and reveals wide variability in alignment with WHO guidelines and limited confidence in providing palliative care. Study findings will inform targeted educational interventions, which must be tailored to the local political, economic, and cultural context

Barriers to the early integration of palliative care in pediatric oncology in 11 Eurasian countries

BACKGROUND: Early integration of palliative care significantly improves quality of life for children with cancer. However, cultural, structural, and socioeconomic barriers can delay palliative care integration into cancer care, particularly in low- and middle-income countries. To date, little is known on the timing of and barriers to palliative care integration in Eurasia. METHODS: The “Assessing Doctors’ Attitudes on Palliative Treatment” (ADAPT) survey evaluates physician perceptions on palliative care integration in pediatric oncology in Eurasia. This evidence-based survey was adapted to the regional context, iteratively reviewed by U.S. and regional panelists, and piloted in English, Russian, and Mongolian. After distribution to physicians caring for children with cancer, statistical analysis was complemented by qualitative analysis of open-ended responses. RESULTS: We received 424 physician responses from 11 countries in the Eurasian region. Study findings demonstrated wide variability in access to palliative care experts across countries (18–96%), with the majority of providers (64%) reporting initial palliative care consultation typically occurs when curative options are no longer available. Providers desired earlier initial palliative care consultation than occurs in their setting (p<0.001). Primary barriers to timely consultation included limited access to palliative care services and specialists, lack of physician education, and perceived family resistance. CONCLUSION: This is the first study identifying physician perceptions of delayed timing of palliative care integration into childhood cancer care in Eurasia and associated barriers. These findings will inform development of targeted interventions to mitigate local structural and cultural barriers to access and facilitate earlier palliative care integration in the region