1. Iowa Cancer Consortium HPV & Cancer Conference April 25, 2016 Susan J. Curry, PhD Distinguished Professor of Health Management & Policy Dean, University of Iowa College of Public Health

2. Although I am a member of the U.S. Preventive Services Task Force (USPSTF), materials provided in this presentation reflect my individual views only and do not represent the views or recommendations of the USPSTF except where noted on individual slides. The overall presentation should not be attributed to the USPSTF.

3.  Overview of HPV prevalence and vaccination in Iowa and nationally  Roll of community-clinical linkages (CCLs) in HPV vaccination initiatives  Summarize current initiatives and best practices in Iowa and nationally

4.  79 million people – 1 in 4 – in the United States are infected with HPV  50-80% of women and men will contract HPV during their lifetime  Each year, 14 million people will become infected with HPV  Roughly half occur between ages 15-24 years American Cancer Society, 2015

5. HPV INFECTION LOW GRADE DYSPLASIA HIGH GRADE DYSPLASIA CANCER Spontaneous remission Spontaneous remission Surgical treatment 15+ years (10,000,000) (3,000,000) (300,000) (11,000) US & CANADA

6. United States (2006-2010)Iowa (2006-2011) Cancer SiteMaleFemaleBoth SexesMaleFemaleBoth Sexes% probably caused by HPV Anus1,5492,8214,3708221029291% Cervix011,422 0602 91% Oropharynx9,9742,44312,41764114778872% Penis1,0480 880 63% Vagina0735 044 75% Vulva03,168 0293 69% Total12,57120,58933,1608111,2962,107 Source: cdc.gov/cancer/hpv/statistics/cases.htm

9.  President’s Cancer Panel, 2014: “Underuse of HPV vaccines are a serious but correctible threat to progress against cancer.” President’s Panel Report, 2014  CDC Director Dr. Tom Frieden declared slow HPV vaccination uptake as one of the top five health threats in 2014  National Foundation for Infectious Diseases (NFID)  2014 Call to Action: HPV Vaccination as Public Health Priority  The Comprehensive Cancer Control (CCC) National Partners  HPV vaccination one of three nationwide priorities

10. National Cancer Institute (NCI) January 2016: 69 NCI-designated centers issue consensus statement. “HPV vaccination is our best defense in stopping HPV infection in our youth and preventing HPV-related cancers in our communities. The HPV vaccine is CANCER PREVENTION.” American Society of Clinical Oncology (ASCO) April 2016 Statement: Improvement in HPV vaccination rates “…could lead to complete eradication of HPV-related cancers in men women.”

11.  Community Preventive Services  “Partnerships between community organizations and vaccination providers are likely to be an essential component of effective, sustained community-based efforts.”  President’s Cancer Panel 2012-2013  “Maximize access to HPV vaccination services, “The range of settings in which HPV vaccines may be administered to adolescents should increase”

12.  Community-clinical linkages (CCLs) are defined by the CDC as “…collaborations between health care practitioners in clinical settings and programs in the community – both working to improve the health of the people and the communities in which they live.” Centers for Disease Control and Prevention. Developing Community-Clinical Linkages for WISEWOMAN Programs. October 8, 2015

13.  Developing strong CCLs are critical for:  Collective ability to improve vaccine access  Improving health outcomes of those eligible for HPV vaccine  Improving sustainability of HPV vaccination programs  Integration is at the Core of the CCL and can take several forms

14.  Mutual  Both share in the identification of individuals (e.g., agree to work together in a single or multiple locations )  Coordinate delivery of services  Share communication to health care providers  Community-focused  Community workers inform/counsel about service  Community workers arrange for service  Community workers provide service  Referral and follow-up to clinical setting as appropriate  Clinically-focused  Community workers inform/counsel about service  Delivery and follow-up provided exclusively in the clinical setting

15. CDC Cooperative Agreement funds 5 HPV-related programs: 1.ACS HPV Roundtable and HPV VACs Project 2.American Pediatric Association (APA) 3.American Academy of Pediatrics (AAP) 4.National Area Health Education Systems Organization (NAO) 5.National Association of County & City Health Officials (NACCHO)

16. HPV Quality Improvement (QI) Program Iowa Chapter of American Academy of Pediatrics Blank Children’s Hospital and UI Children’s Hospital  QI Training and Application  Facilitate Peer-to-Peer Education  Strong Provider Recommendations  Increase State Capacity for Improving HPV Vaccination Rates

17.  Scenic Rivers Area Health Education Center (AHEC)  National AHEC Organization (NAO) ‒ Clinician outreach and training ‒ Educational materials ‒ Strong partnerships ‒ Prioritization of HPV vaccination efforts  Supporting Local Health Departments to Increase HPV Vaccination Rates Project  Dallas County & Linn County  National Association of County and City Health Officials (NACCHO) ‒ Engagement of key stakeholders ‒ Support effective and evidence-based HPV vaccination programs ‒ Strong partnerships

18. Cancer Prevention and Control Research Network (CPCRN) University of Iowa College of Public Health  Thematic research network of 8 institutions  Collaboration of CDC and NCI  Mission: Accelerate the adoption of evidence-based cancer prevention and control in communities Iowa Research Focus  HPV Vaccination Signature Project  Internal Project in West Liberty

19. CPCRN Signature Project: HPV Vaccination University of Iowa College of Public Health CPCRN CPCRN HPV Vaccination Workgroup aims to increase HPV immunization in varying populations and community settings through:  Assessment of specific population needs  Innovative community-clinical linkages (CCLs)  Systematic identification and dissemination of best practices

20. National HPV Vaccination Roundtable Pharmacy-located HPV Vaccination Pilot Project University of Iowa, University of Kentucky, Oregon Health & Science University February-September 2016 Project Overview  Assess feasibility of coordinated HPV vaccination through community pharmacy-clinic collaborations  Health clinics: 1 st dose, prescription to pharmacies for doses 2 and 3  Pharmacies: 2 nd and 3 rd dose, at 2 and 6 months, respectively

21. Questions, comments? Thank You