Feasibility and acceptability of telehealth and contactless delivery of human papillomavirus (HPV) self-testing for cervical screening with Maori and Pacific women in a COVID-19 outbreak in Aotearoa New Zealand.

AIM: To determine the feasibility and acceptability of a telehealth offer and contactless delivery of human papillomavirus (HPV) cervical screening self-test during the 2021 COVID-19 Level 4 lockdown in Auckland, New Zealand. METHODS: A small proof-of-concept study was undertaken to test telehealth approaches in never-screened, due or overdue Maori and Pacific women enrolled in a local Primary Health Organisation (PHO). Study invitation, active follow-up, nurse-led discussions, result notification and a post-test questionnaire were all delivered through telehealth. RESULTS: A sample of 197 eligible Maori and Pacific women were invited to take part, of which 86 women were successfully contacted. Sixty-six agreed to take part. Overall uptake was 61 samples returned (31.8%) and uptake of all contactable women was 70.9%. Six of the 61 HPV self-tests (9.8%) were positive, all for non 16/18 types, and were referred for cytology. Three had negative cytology results, and three with positive cytology results were referred for colposcopy. CONCLUSION: The offer of HPV self-testing during COVID-19 lockdown was both feasible and highly acceptable for Maori and Pacific women. Importantly, HPV self-testing via telehealth and mail-out, alongside other options, offers a potential pro-equity approach for addressing the impact of deferred screens due to COVID-19 and other longstanding coverage issues.

Structural disadvantage for priority populations: the spatial inequity of COVID-19 vaccination services in Aotearoa.

AIM: To examine the spatial equity, and associated health equity implications, of the geographic distribution of COVID-19 vaccination services in Aotearoa New Zealand. METHOD: The distribution of Aotearoa's population was mapped, and the enhanced two-step floating catchment method (E2SFCA) applied to estimate spatial access to vaccination services. The Gini coefficient and spatial autocorrelation measures assessed the spatial equity of vaccination services. Additional statistics included an analysis of spatial accessibility for priority populations, and by District Health Board (DHB) region. RESULTS: Spatial accessibility to vaccination services varies across Aotearoa, and appears to be better in major cities than rural regions. A Gini coefficient of 0.426 confirms that spatial accessibility scores are not shared equally across the vaccine-eligible population. Furthermore, priority populations including Maori, Pasifika, and older people have statistically significantly lower spatial access to vaccination services. This is also true for people living in rural areas. Spatial access to vaccination services also varies significantly by DHB region as does the Gini coefficient, and the proportion of DHB priority population groups living in areas with poor access to vaccination services. A strong and significant positive correlation was identified between average spatial accessibility and the Maori vaccination rate ratio of DHBs. CONCLUSION: COVID-19 vaccination services in Aotearoa are not equitably distributed. Priority populations, with the most pressing need to receive COVID-19 vaccinations, have the worst access to vaccination services.

The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand-a country pursuing COVID-19 elimination.

BACKGROUND: The COVID-19 pandemic has disrupted cancer services globally. New Zealand has pursued an elimination strategy to COVID-19, reducing (but not eliminating) this disruption. Early in the pandemic, our national Cancer Control Agency (Te Aho o Te Kahu) began monitoring and reporting on service access to inform national and regional decision-making. In this manuscript we use high-quality, national-level data to describe changes in cancer registrations, diagnosis and treatment over the course of New Zealand's response to COVID-19. METHODS: Data were sourced (2018-2020) from national collections, including cancer registrations, inpatient hospitalisations and outpatient events. Cancer registrations, diagnostic testing (gastrointestinal endoscopy), surgery (colorectal, lung and prostate surgeries), medical oncology access (first specialist appointments [FSAs] and intravenous chemotherapy attendances) and radiation oncology access (FSAs and megavoltage attendances) were extracted. Descriptive analyses of count data were performed, stratified by ethnicity (Indigenous Maori, Pacific Island, non-Maori/non-Pacific). FINDINGS: Compared to 2018-2019, there was a 40% decline in cancer registrations during New Zealand's national shutdown in March-April 2020, increasing back to pre-shutdown levels over subsequent months. While there was a sharp decline in endoscopies, pre-shutdown volumes were achieved again by August. The impact on cancer surgery and medical oncology has been minimal, but there has been an 8% year-to-date decrease in radiation therapy attendances. With the exception of lung cancer, there is no evidence that existing inequities in service access between ethnic groups have been exacerbated by COVID-19. INTERPRETATION: The impact of COVID-19 on cancer care in New Zealand has been largely mitigated. The New Zealand experience may provide other agencies or organisations with a sense of the impact of the COVID-19 pandemic on cancer services within a country that has actively pursued elimination of COVID-19. FUNDING: Data were provided by New Zealand's Ministry of Health, and analyses completed by Te Aho o Te Kahu staff.

Telehealth as a tool for equity: pros, cons and recommendations

Before the start of the second school term, and within a few weeks of our move to Alert Level 4, the New Zealand Government began distributing more than 17,000 digital devices to school students around the country1 In addition, thousands of modems were circulated to households without current internet access-all in an effort to bridge the digital divide and enable online learning amid the COVID-19 shutdown.2 In the context of health, clinical consultations that do not require in-person contact have moved to phone calls and video-conferences. The factors that drive poor healthcare access for Māori and Pacific peoples are multifactorial, but ultimately these factors reflect a disproportionate exposure to the multiple determinants of poor health (including health systems and social determinants such as socioeconomic deprivation and institutionalised racism).89 These are the social determinants that manifest as barriers to healthcare access for Māori and Pacific people: transportation barriers that prevent access to in-person appointments;financial barriers that prevent paying for general practitioner (GP) visits or medication;and cultural barriers that prevent access to a service that was not necessarily designed to align with Māori and Pacific worldviews of health-with the understanding that access is not solely premised by availability and affordability, but also acceptability of services for Māori and Pacific people. Opportunities Telehealth can reduce barriers to care. Since telehealth reduces or removes the requirement for patients to travel to receive care, it follows that telehealth can improve access to care among those who have transport barriers.1012 By removing the necessity to travel for care, telehealth also reduces the time commitment required by patients and their whanau, further improving access to care. Technical barriers to the equitable provision of telehealth for Māori and Pacific people include (but are not limited to): the availability of telephone or internet connection;device availability (including telephones and other communication devices);digital literacy/education regarding device usage;infrastructure, education and resourcing within Māori and Pacific health providers to provide telehealth to their communities;and attitudinal barriers to telehealth uptake among some health professionals.