National Cervical Screening Programme Sector Update - August 2022
Kia ora koutou
We are excited to be launching a social media campaign aimed at encouraging wāhine to re-engage with regular cervical screening.
You’ll find more details about this campaign in this Sector Update but the core message is that regular cervical screening will lead to the early detection of cell changes that can be treated, to prevent cervical cancer.
This is particularly true for Māori wāhine and participants who have twice the rate of cervical cancer compared to non-Māori and are twice as likely to die from it. This social media campaign has been designed in particular to resonate with these wāhine and other participants, because we need to normalise the conversation about regular cervical screening.
We can do this by improving access and opportunities that support getting more participants into our cervical screening programme, and by reinforcing the key message that HPV vaccination combined with regular screening provides the best protection from cervical cancer.
With the transition to HPV Primary Screening, we are aiming to bring more participants into the screening programme. Until then, please reinforce our key messages, point people towards the social media campaign and encourage participants to continue their regular screens.
What’s happening in the NCSP
Cervical Screening Media Campaigns
The NCSP’s Māori social marketing campaign to promote a safe return to cervical screening after the disruptions caused by COVID-19, is going live
Messaging and four videos developed in partnership with Māori and Pacific Campaign Advisory Groups (CAGs) will soon be on the Time to Screen website under the heading “Hey, Let’s Catch up!”
These have been designed with Māori and Pacific creative agencies and separated into distinct campaigns. The Māori-focused campaign is being launched now, followed by the Pacific-focused campaign later in the year.
The Māori cervical screening campaign tells real and relevant local stories by going to where wāhine Māori are. A whānau approach acknowledges the importance of whakapapa and the value of the whole family being supportive of cervical screening, alongside the wāhine.
The campaign acknowledges the sacredness of te whare tangata and the importance for wāhine to focus on their own health and that of their whānau.
Finding the time for screening can be difficult but wāhine prioritising themselves is important so that they can be healthy for their whānau .
NCSP Parliamentary Review Committee
The three-yearly NCSP Parliamentary Review has progressed its work after conducting interviews with providers and stakeholders and is now in the collation and writing phase prior to submitting its report.
The final report will be presented to the Minister in early September and will then be tabled in Parliament.
We are looking forward to hearing the Review’s recommendations in areas such as accessibility to primary health care and colposcopy services.
Please refer to the following link for background to the NCSP Review
NCSP Advisory and Action Group
A refreshed NCSP Advisory and Action Group will provide strategic advice and guidance to the cervical screening programme, in particular for the implementation of HPV Primary Screening.
The Group includes members with experience of all stages of the screening pathway and is focused on equity. We will work alongside this group in a partnership model which will inform our approach to all our groups advising the National Screening Unit.
Tira Albert, Kaiwhakahaere of Mana Wāhine, and member of the Māori Monitoring and Equity Group and NCSP Māori Campaign and Resources Advisory Group, chairs the group, alongside Jane O’Hallahan, Clinical Director of the National Screening Unit.
Group members are:
- Bev Lawton of Hei Āhuru Mōwai, is Professor and Director of Te Tātai Hauora o Hine (National Centre for Women’s Health Research Aotearoa)
- Carmen Rewi-de Joux is a Clinical Nurse Specialist in Women's Health with Te Whatu Ora - Southern
- Emily Cavana of the Royal New Zealand College of General Practitioners, representing primary care, is currently a medical educator for RNZCGP and a clinician at Vibe Youth Service
- Linda Moir is the Charge Nurse Manager for the Cervical Screening Programme, Population Health Administration Team, Sexual Health, SAATS, and NIR at Te Whatu Ora – Southern
- Elizabeth Pringle of the New Zealand Institute of Medical Laboratory Science, representing laboratories, is the Scientist Unit Manager Clinical Support Directorate, Pathology and Laboratory Medicine, Anatomic Pathology Service Auckland Te Whatu Ora
- Nerida Matangi-Griffiths is the current Specialty Clinical Nurse/Regional Co-ordinator for Te Whatu Ora – Waikato, National Cervical Screening Programme
- Ruth Swarbrick of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, representing colposcopists, is a consultant obstetrician and gynaecologist working at Te Whatu Ora – Lakes
- Sandra Corbett of the Māori Women’s Welfare League, Te Rōpū Wāhine Māori Toko I te Ora, is currently the Kaiwhakahaere for Population Screening at Te Whatu Ora – Hawke’s Bay
- Tiffany Soloa'i is a Practice Support Nurse with the National Hauora Coalition, across the Metro Auckland and Whanganui areas, with a particular focus on immunisations and cervical screening
- Tua Taueetia-Su'a is a Senior Research Fellow Auckland University, Pacific Health Advocate and current chair of the NCSP Pacific Campaign and Resources Advisory Group
- Wendy Burgess is a Māori Obstetrician Gynaecologist at Waitematā Health and Senior Lecturer at Waipapa Taumata Rau
- Yvonne Little of the New Zealand College of Primary Health Care Nurses, is a Nurse Practitioner in the Primary Health Care Sector in Hawke’s Bay
More information, including minutes from each hui, brief bios of the members and points of contact, will be available on the NCSP website.
We will bring you updates on this group’s work in future.
Data Monitoring and Analytics
The Screening, Insights and Analytics (SIA) team are the data-subject-matter experts within the National Screening Unit (NSU). They produce reports for the national screening programmes which are required for monitoring purposes.
They respond to custom requests for data and analysis from a wide range of areas - including policy, academia and Parliamentary. The national screening programmes all have several key targets they must meet, and the assessment against those targets requires timely data analysis and reporting. The SIA team provide this reporting function across all six screening programmes within the NSU.
SIA are currently working on regular NCSP Programme reporting as well as responding to custom data requests from both within the NSU and external parties.
The Coverage App for SIA shows a key performance measure for the NCSP as it measures how many people are actively screening. Coverage is defined as the proportion of women eligible for screening who have been screened in a given time period.
SIA are working alongside the HPV Primary Screening Project team to ensure that programme reporting and monitoring will be in place throughout the transition to HPV Primary Screening in July 2023.
They are also working closely with the NSU Clinicians and Te Tiriti and Equity Rōpū to understand requirements for Māori data governance, assessment and reporting, to put together an approach that will align to National Kaitiaki regulations.
New Support to Screening Services Web Page
In last month’s Sector Update we gave details of training services available for sample takers, which will help our campaign to boost screening numbers.
Now, we are aiming to create a new web page for our SSS teams.
This will include a map showing where services are located, plus contact details for access points to those services.
Look out for more information about this in the September edition of Sector Update.
Cervical Screening Awareness Month
Some key dates are coming up in the next couple of months, which we have shared with regional coordinators and SSS groups.
Cervical Screening Awareness month is in September.
Prior to that the Smear Your Mea day/weekend will run from 26 –28 August. The significance of this is that 26 August 2017 was the day the late Talei Morrison, the founder of SYM, was diagnosed with cervical cancer.
The SYM Trust has endorsed continuation of these dates in remembrance of Talei and to recognise the engagement that Smear Your Mea has with wāhine and whānau to emphasise the importance of cervical screening.
Please note these key dates. Any regional approaches for greater engagement, to coincide with these key dates, would be appreciated.
What’s happening with the HPV Primary Screening Project
July 2023 remains the target date for the move to HPV Primary Screening.
As we engage more closely with health professionals, we learn more about what the sector wants to know, and what information you require.
We have been attending different hui to share information about the change to HPV Primary Screening and talk through what this means for you.
Our Sector Working Groups are going to be a key part of this engagement and we have shared details below.
Sector Working Groups
The newly-realigned Sector Working Groups that will be needed to advise throughout the Implementation Phase of the Project, are now starting work as we prepare for the transition to HPV Primary Screening in July 2023.
These groups have specific tasks to make sure that transition works in a clinically-safe way. They will:
- Provide expert advice, guidance and advocacy needed to ensure the successful transition to HPV Primary Screening
- Inform the development of, and provide feedback on, the Register functionality, resources, training materials and delivery approaches
- Identify challenges and opportunities the sector might have to the proposed changes, and
- Act as change champions, advocate for the HPV Primary Screening Project and build trust in the sector for the changes to cervical screening.
The Screen Takers Working Group met on 26 July and the Colposcopy Working Group on 27 July.
Both the Register Working Group and the Kaimanaaki Working Group are meeting on 3 August.
The Laboratory Working Group will have its first meeting after the formal RFP process has concluded and we know which laboratories will be involved in the HPV Primary Screening and associated cytology work after July 2023.
We are now focusing on appointing chairs for each group, from members of the NCSP Action and Advisory Group who also sit on the Working Groups.
We will come back to you with more information as the Working Groups progress their work.
New HPV Primary Screening resources
We have been seeking sector input to support the development of public-facing resources for participants and their whānau. We are collating the feedback from the survey to discuss with the Māori and Pacific Campaign Advisory Groups and will then consult further with the HPV Primary Screening Working Groups.
Thanks to all those who took the time to complete the survey and share your views on the collateral that is available now (pamphlets, websites etc.). We had a great response.
We will be engaging a provider to include focus groups to ensure resources meet the needs of wāhine, disability groups and LGBTQI+.
We will keep the sector updated as this work progresses.
Updated Clinical Practice Guidelines
The newly-edited Draft NCSP Clinical Practice Guidelines for Cervical Screening in New Zealand are being shared with the Working Groups.
The current feedback we are looking for purely concerns readability and clarity of the new Draft, as the detailed consultation on the clinical pathway was completed last year.
We have received one request from a professional body to view the Draft and have done so on the above basis, noting also that the introductory section is still being redrafted and therefore the document is not is its final form.
A deadline of Tuesday 9 August has been set for feedback, which will then allow us to complete the final version of the Guidelines.
The evaluation of bids received under the request for proposals (RFP) for laboratory work required under HPV Primary Screening has now been completed.
The formal RFP process is therefore still active and Te Whatu Ora – Health New Zealand will not be commenting until negotiations have been successfully concluded.
The new Register will be accessed by many more health professionals than the current version. It will be population-based, giving us the opportunity to look for new functions that will benefit the sector to support wāhine, other participants and whānau.
Our focus is on ensuring the design of the new Register effectively supports the new clinical pathway and enables health providers to have direct look-up access to screening histories to support participants on their screening journey. It will enable improved reporting and monitoring.
Two major functions we are working on are centralised notification (covering the first notification for someone starting on the screening programme) and recall (when someone already in the screening programme is notified about their next screen being due). The focus of this is to support administrative tasks to be managed centrally.
It is important to know that we are at the start of a developing journey and that we will give the sector an opportunity to shape the decisions we will make on the Register.
Over the coming months we will be working through the detailed requirements for access rights for different groups (e.g. who can read-only, who can edit, etc.). We will be reaching out to the sector for feedback as we design these improvements.
Self Testing and Choice
It's a good time for us to provide you with some clarifications on self-testing at home, and the choices available to participants, as we have become aware of different viewpoints in the sector as to what will be allowed when HPV Primary Testing goes live in July 2023.
The first thing to note is that self-testing will be available in primary health care and community settings. This includes the participant doing the test in a place of their choice, including at home.
The definition of “self-testing” is a test taken by the participant in any setting acceptable to them with the health provider providing clinical oversight.
Clinical oversight in the context of self testing means that the health professional is responsible for:
- Giving advice and getting the informed consent of the participant
- Providing the test kit to the participant (the scope limit of the HPV Primary Screening Project means that we cannot send out test kits centrally)
- Coordinating and receiving the test back
- Ensuring the necessary Quality Assurance requirements are met (labelling/date etc)
- Ensuring the correct lab request information is completed
- Ensuring the participant is told of the test result
- Ensuring the result is followed up and the next steps/referrals are completed as appropriate.
It is also important to know that self-testing is NOT the only option available to the participant from July 2023 (we have been made aware some in the sector have thought this is the case).
The participant has choices about the way their sample is taken.
After receiving advice from the clinician, they have the choice of whether to have a swab-taken sample (used for HPV testing only) or a clinician-taken sample using a speculum. A clinician-taken sample can then be used for HPV testing as well as cytology if required.
If the participant wishes to have a swab-taken sample, this can be either a self-test, where they take the sample themselves, or they can have a clinician support person assist by using the swab to collect the sample for them.
Participants should be fully informed of their options in order to make a personal choice.
We hope this clarifies the position regarding self-testing and participant choice. If you have any questions, please contact us at [email protected]
Answers to Your Questions
Our new email address is proving a big success in giving health professionals a direct channel to contact the HPV Primary Screening Project Team and ask questions. We highlight recent queries below.
One query we received is whether immunisation details will be captured in the new Register.
Both the NCSP Programme and the HPV Primary Screening Project team are aware of this as a requirement.
A technical interface does not currently exist with the National Immunisation System (NIS). However, the NIS system is now being upgraded/replaced and once this has been completed, we will look to provide integration into the new NCSP-Register.
This will not be part of the initial release. However, once the new NIS system is built, we can look at pulling the immunisation data into the new Register.
A second question – this time from the media – related to the benefits that HPV Primary Screening would provide for gender-diverse participants. A recent media article focused on a trans-gender man who missed being recalled for a screening when he changed his gender marker in the health system about eight years ago.
Currently, recalls are not handled from a centralised Register, but by individual health providers.
The NCSP provides cervical screening services to women and people with a cervix aged 25 to 69 years of age.
The programme change to HPV Primary Screening provides choices for people with a cervix who experience whakamā (embarrassment) with the current test and find it unacceptable and/or uncomfortable. In addition, research suggests transgender and non-binary people with a cervix would prefer the option to self-test.
The new system is being developed to support gender diversity and will capture data from the centralised National Health Index (NHI) and the National Enrolment service (NES). In addition, providers can enrol those who are eligible and not captured in the NHI/NES including people whose self-identified gender differs from their biological sex.
As part of the programme change, NCSP is developing education and training for health professionals providing screening services and is developing resources that will support information to meet the needs of the LGBTQI+ communities.
The future campaign approach to promote awareness of cervical screening and choices to self-test is currently in development and will include consideration of the approaches that that will support gender-diverse people to access screening services
Key messages to share about the HPV Virus:
- The National Cervical Screening Programme (NCSP) is changing the way cervical screening is undertaken in New Zealand
- From July 2023 the primary test for cervical screening will change to a human papillomavirus (HPV) test
- This new screening method will test for the presence of HPV, the cause for 99% of cervical cancers
- Around 80% of participants who develop cervical cancer in New Zealand have either never been screened or have been screened infrequently
- Self-testing with clinical oversight will be an option for all participants and their whānau
- The screening interval following a negative test will change to 5 years
- HPV vaccination combined with regular screening provides the best protection from cervical cancer.
More key information to give wāhine/whānau is provided on the website Frequently asked questions | National Screening Unit (nsu.govt.nz)
Staying in Touch
Lots of people are passing on our Sector Update and our distribution list has increased dramatically over the last couple of months. If you know of anyone who wants to have their name added to the Sector Update distribution list, please let us know by dropping us a line.
Your thoughts and queries are what we want to hear as we engage with you and communicate more in the coming months.
Please use our new email address [email protected]. Your feedback is important to us.