HPV knowledge and self-sampling for the detection of HPV-DNA among Inuit women in Nunavik, Quebec

The prevalence of human papillomavirus (HPV), a necessary cause of cervical cancer has been found to be high in Inuit populations. This study examined 1) the level of knowledge about HPV infection and its relation to cervical cancer and 2) the comparability of self-collected cervicovaginal samples to provider-collected cervical samples for the detection of HPV and to assess preference of sampling methods among Inuit women in Nunavik, Quebec. Questionnaires were used to measure HPV knowledge and sampling method preference. To assess comparability of sampling techniques, samples were tested for 36 HPV types with PCR. Previous awareness of HPV was reported by 31% of women. The level of knowledge about HPV was low, but similar to that of other non-Indigenous populations. The agreement in detection of high-risk HPV between paired observations was found to be high. Self-sampling is comparable to provider-sampling and is a promising intervention to increase coverage of cervical cancer screening.La prévalence du virus du papillome humain(VPH) est élevée dans la population Inuit du Québec. Nous avons donc 1) documenter le niveau de connaissance concernant le VPH et son lien avec le cancer du col utérin et 2) évaluer le rendement de l'auto prélèvement pour le VPH en comparaison avec le prélèvement fait par l'intervenant de santé et 3) déterminer la préférence des femmes Inuit du Nunavik entre les deux méthodes. Un questionnaire fut utilisé pour évaluer le niveau de connaissance et la préférence entre les modes de prélèvements. La comparabilité entre les modes de prélèvements s'est effectuée sur les résultats du test PCR détectant 36 différents types de VPH. Plus de 31% des femmes Inuit avaient entendues parler du VPH. Le niveau de connaissance général sur le VPH est faible mais semblable à celui rapporté pour des populations non Autochtone. La comparabilité en matière de détection des VPH est élevée entre les deux méthodes. L'auto prélèvement est potentiellement une méthode de prélèvement propice à augmenter le taux de dépistage du cancer du col utérin

Assessing barriers to health insurance and threats to equity in comparative perspective: The Health Insurance Access Database

Abstract Background Typologies traditionally used for international comparisons of health systems often conflate many system characteristics. To capture policy changes over time and by service in health systems regulation of public and private insurance, we propose a database containing explicit, standardized indicators of policy instruments. Methods The Health Insurance Access Database (HIAD) will collect policy information for ten OECD countries, over a range of eight health services, from 1990–2010. Policy indicators were selected through a comprehensive literature review which identified policy instruments most likely to constitute barriers to health insurance, thus potentially posing a threat to equity. As data collection is still underway, we present here the theoretical bases and methodology adopted, with a focus on the rationale underpinning the study instruments. Results These harmonized data will allow the capture of policy changes in health systems regulation of public and private insurance over time and by service. The standardization process will permit international comparisons of systems’ performance with regards to health insurance access and equity. Conclusion This research will inform and feed the current debate on the future of health care in developed countries and on the role of the private sector in these changes.</p

Inuit women&#x0027;s attitudes and experiences towards cervical cancer and prevention strategies in Nunavik, Quebec

Objectives: To describe the attitudes about and experiences with cervical cancer, Pap smear screenings and the HPV vaccine among a sample of Inuit women from Nunavik, Quebec, Canada. We also evaluated demographic and social predictors of maternal interest in HPV vaccination. Study design: A mixed method design was used with a cross-sectional survey and focus group interviews. Methods: Women were recruited through convenience sampling at 2 recruitment sites in Nunavik from March 2008 to June 2009. Differences in women&#x0027;s responses by age, education, and marital status were assessed. Unconditional logistic regression was used to determine predictors of women&#x0027;s interest in HPV vaccination for their children. Results: Questionnaires were completed by 175 women aged 18&#x2013;63, and of these women a total of 6 women aged 31&#x2013;55 participated in 2 focus groups. Almost half the survey participants had heard of cervical cancer. Women often reported feelings of embarrassment and pain during the Pap smear and older women were more likely to feel embarrassed than younger women. Only 27% of women had heard of the HPV vaccine, and 72% of these women were interested in vaccinating their child for HPV. No statistically significant predictors of maternal interest in HPV vaccination were found. Conclusions: Our findings indicate that health service planners and providers in Nunavik should be aware of potential barriers to Pap smear attendance, especially in the older age groups. Given the low awareness of cervical cancer, the Pap smear and the HPV vaccine, education on cervical cancer and prevention strategies may be beneficial

HPV Dectection by Self-Sampling in Nunavik, Quebec: Inuit Women’s Sampling Method Preferences

There is a higher incidence of cervical cancer and prevalence of genital human papillomavirus (HPV) infection among the Inuit in Canada than the general population. Self-sampling of cervicovaginal cells for HPV testing has the potential to increase cervical cancer screening coverage in this population, but only if it is acceptable to women. We sought to determine acceptance of and preference for self-collection of cervicovaginal samples for HPV testing in comparison with provider-collection, and to explore demographic characteristics of preference for self-collection among a sample of Inuit women from Nunavik, Quebec. Women aged 18–69 years were recruited from a previously formed cohort on the natural history of HPV in Nunavik. Both self-collected and provider-collected specimens were collected with polyester-tipped swabs, and women completed a short written questionnaire immediately after specimen collection. Logistic regression was used to estimate predictors of preference. Of the 109 eligible women who were approached to participate, 93 (85%) accepted. Self-sampling was preferred by 56% of the women over provider-sampling. Education was the only predictor of preference for self-sampling, where having at least a grade 9 education was inversely associated with preference for self-sampling (OR = 0.29, 95% CI [0.09, 0.92]). Self-sampling has the potential to increase cervical cancer screening coverage, but any implementation of self-sampling should be concurrent with an education campaign on the importance of cervical cancer screening, the relationship between HPV virus and cervical cancer, and the accuracy of self-sampling

Persistence of human papillomavirus 16, 18 and 52 variants in Inuit women from Northern Quebec, Canada

Intratypic DNA polymorphism has been described for human papillomavirus (HPV) types infecting Inuit women in Nunavik, Quebec, a high-risk population for HPV infection and cervical cancer, but there is no previous research on the association between HPV polymorphism and infection persistence in Inuit women. Polymorphism of HPV types 16, 18 and 52 was described in a subset of 64 participants with multiple clinic visits within a cohort of 677 Nunavik Inuit women aged 15–69 recruited in 2002–2010 with testing results. Logistic regression and Cox proportional hazards models were used to assess the association between HPV variants and infection persistence and clearance. Infections with HPV16 lineage A3 variants cleared 3.13 times faster (95% CI: 1.10–8.97) than those with lineage A1 variants. HPV52 lineage C variants cleared slower than lineage A variants (HR = 0.28, 95% CI: 0.08–0.98). HPV polymorphism may be associated with viral persistence for certain HPV types in this population

Inuit women’s attitudes and experiences towards cervical cancer and prevention strategies in Nunavik, Quebec

To describe the attitudes about and experiences with cervical cancer, Pap smear screenings and the HPV vaccine among a sample of Inuit women from Nunavik, Quebec, Canada. We also evaluated demographic and social predictors of maternal interest in HPV vaccination. [...