Prevention of Cervical Cancer Introduction of the Human Papillomavirus (HPV) Vaccination

1. Prevention of Cervical Cancer Introduction of the Human Papillomavirus (HPV) Vaccination 17 February 2014

2. Presentation Overview • Background • Introduction of HPV • Planning • Monitoring & evaluation • Training • Social mobilisation • Conclusion

3. The introduction of the human papillomavirus (HPV) vaccine marks a major public health milestone for South Africa

4. Global Burden of Cancer of Cervix (CaCx) • The second most common cancer in women in developing countries. • Every year, cancer of cervix accounts for an estimated: • 530,000 new cases • 275,000 deaths • Over 85% of cases occur in developing countries • By 2050: • one million cases • 90% in developing countries

5. Cervical Cancer Kills Women Everyday • Globally one woman dies every 2 minutes from Cervical Cancer • In South Africa, each year approximately • 5,743 women will develop cervical cancer1 • 3,027 women will die from cervical cancer1 1.IARC GLOBOCAN 2008: Cancer incidence, mortality and prevalence worldwide

6. Cervical Cancer & HPV HPV stands for human papillomavirus. Human Papillomavirus: there are some 40 types of HPV can infect the genital area. HPV-16 and HPV-18 are found to cause over 70% of the cervical cancer cases

7. How common is HPV? • It is very common among sexually active people. • Three out of four people have the HPV at some point in their lives. How do people get HPV? • Most commonly, from vaginal and anal intercourse. • Less commonly, from skin-to-skin genital contact or oral sex.

8. HPV Infections Can Be Prevented Vaccines are available to prevent HPV infections Their are vaccines that target specific strains of HPV The World Health Organisation recommends vaccinating sexually naïve girls with the HPV vaccine at 9 years of age

9. Introduction of HPV Vaccine S Africa • Commitment to introduce HPV vaccine in 2014 was made in the 2013 Health Budget • The HPV vaccination chosen will target preventing HPV-16 and HPV-18 infections as these most commonly cause cervical cancer • The HPV vaccine will be delivered at all Public schools. • The target group is quantified to approximately 500 000 girls in 17 000 schools (based on data from DBE)

10. How the HPV Programme will be Delivered? • The platform for delivery of the HPV vaccine will be through the Integrated School Health Programme (ISHP). • The HPV vaccine will be delivered as an outreach service to schools twice a year, every year. • All public schools including special schools will be visited by HPV vaccination teams will visit schools twice a year. • Two doses of the vaccine will be given 6 months apart

11. HPV VACCINE REQUIREMENTS

12. KEY DATES : Annual HPV Vaccination Campaign YEAR PLAN 2014 1stRound Annual HPV Vaccination Campaign (Dose 1) 10- March to 11 April 2014 2ndRound Annual HPV Vaccination Campaign (Dose 2) 29 September- 31 October 2014

13. HPV Vaccine Planning

14. Co-ordination of HPV Vaccination Sub Groups

15. COMPONANTS Implementation HPV Vaccination

16. HPV VACCINATION PLAN Schools Schools Schools Schools Schools

17. Implementation of HPV Vaccination Programme Each province has • HPV implementation plan • District & Facility Micro-plans • Vaccine distribution plan for all levels • Assessed cold chain capacity for storage of vaccine

18. Human Resources HPV vaccination team • Nurse who can vaccinate (professional nurse or and enrolled nurse) • Support staff (will conduct the administrative functions during the vaccination session). • Additional team members for schools with large number of grade 4 girls so that the vaccinations can be completed in 1 day. School Health Teams will be dedicated to HPV vaccination for duration of campaign All CHC/PHC staff/hospitals should be used where necessary, similar to other vaccine campaigns Student nurses and SAMHS staff NGO’s and CBO’s Civil society groups

19. HPV vaccine collection sites • Will have dedicated HPV vaccine team available - to visit schools during the campaign to administer the HPV vaccine. • Are in close proximity to the schools - facilitate the team visiting more than one school a day • HPV vaccine teams are required to go beyond the target of 30-40 schoolsduring the campaign month. • Will have sufficient cold chain capacity to store HPV vaccines • Will have access to transport for the team to visit the schools • Will have a pharmacist or a pharmacy assistant is available to manage the vaccine stock

20. HPV Vaccine Programme Monitoring and Evaluation

21. Reporting and recording systemfor HPV vaccine Monitoring Evaluation 1 2 3 Vaccination cards for individual girls vaccinated Vaccination register per school Weekly Summary Sheet (at HPV collection sites) Completed by team HPV team 5 4 Evaluate results in the middle-long term, based on National Statistics and the Cancer Registry District Health Information System

24. HPV Vaccine Training

25. Training • HPV training programme with training materials Vaccine management (SOPs) • Vaccine administration (SOPs) • Cold Chain management • Monitoring & Evaluation • Adverse events monitoring • Social mobilisation & communication

26. HPV Vaccination Training

27. HPV Vaccine Social Mobilisation

28. Social Mobilisation & Communication • Social mobilisation and communication strategy and plan • Target audience communities, parents and family members of grade 4 girls • Social mobilisation and communication • Letter of invitation to parents of grade 4 girls • HPV information on consent forms • Posters (classrooms) • Fact sheets • FAQ • Script for information session • Media statement • Press release • Radio/TV adverts ( scheduled for 2 weeks in all 11 official languages on SAFM radios)

29. HPV INFORMATION PACK Guide for educators Ministers invitation letter HPV Consent forms HPV Poster

30. INVITATION Grade 4 Girls

31. Information Filled in by parents/ guardians/ caregivers

32. Information Filled in by parents/ guardians/ caregivers

33. Parental Consent for HPV Vaccination HPV Posters • Intended to inform the grade 4 girls about the HPV vaccination. • Write the datesof the HPV vaccination team are scheduled to visit your school. • Display posters in the grade 4 classroom at least two weeks before the HPV vaccination session. • Can remain in the classroom until the second dose of the HPV vaccination.

34. HPV POSTER

35. Consent Process for HPV vaccination • All girls in grade 4 must receive the HPV Grade 4 girls and parents information pack before the vaccination session at the school. • Inform the girls that the consent forms must be returned to the school as soon as possible. • If the consent forms are not returned to the school at least 1 week before the vaccination session please remind girls to return the consent form. Please note: that all consent forms need to be returned irrespective of whether consent for the HVP vaccination is granted or not.

36. DBE Support for HPV Vaccination in Schools • Provincial level: Participate in provincial and district and local level planning • District level: planning and communication • School level: • Assist with access to learners • Disseminate information to learners and parents • Obtain consent from parents/guardians/care-givers • Provide list of Grade 4 learners • Assist with logistical arrangements during the vaccination session at schools • Maintain school & Learner Records in line with standard ISHP procedures

37. How can School Governing Bodies Support? Advocacy • Inform school governing bodies and parents about the HPV campaign at SGB and parent teacher meetings • Promote the benefit of the HPV vaccination to parents and communities • Help parents understand the importance of having their daughters vaccinated Logistics • Facilitate parents signing consent forms • Ensure that your schools are visited by the HPV vaccination team • Alert us if the vaccination has not taken place in your schools

38. Conclusion Success of this programme will depend on us working together We can collectively positively influence the uptake of the HPV vaccine in South Africa.