ABSTRACT
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.
Subject(s)
Alphapapillomavirus , COVID-19 , Papillomavirus Infections , Telemedicine , Uterine Cervical Neoplasms , Female , Humans , Pregnancy , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control , Uterine Cervical Neoplasms/epidemiology , Self-Testing , Early Detection of Cancer/methods , Native Hawaiian or Other Pacific Islander , Feasibility Studies , COVID-19/diagnosis , COVID-19/epidemiology , New Zealand/epidemiology , Communicable Disease Control , Papillomaviridae , Colposcopy , Mass Screening , Disease Outbreaks , Vaginal SmearsABSTRACT
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.