1. Oregon Tribes and HPV Oregon HPV Roundtable
Kerri Lopez
Northwest Tribal Comprehensive Cancer Program
May 2018
Supported by CDC Grant #U158/DP

2. Northwest Portland Area Indian Health Board
NPAIHB Member Tribes
Name and location of your coalition. If you are a 501c3, and the basic structure of your coalition:
Northwest Tribal Comprehensive Cancer Coalition in the Northwest Tribal Epidemiology Center
Office in Portland, Oregon
We are a 501c3 and PL 638 Federal Contractor serving 43 Federally recognized tribes in Idaho, Oregon, and Washington
Chair from member tribes and open coalition
11/12/2018
Northwest Portland Area Indian Health Board

3. Northwest Portland Area Indian Health Board
Organizational Chart
11/12/2018
Northwest Portland Area Indian Health Board

4. About our Board:
Board Delegates meet quarterly and in other State/Tribal meetings
Provide program guidance to state, federal, and others
Review HHS/IHS policy issues affecting Tribal health programs
Currently looking at health care reform effects
Discuss and Develop consensus positions on:
Legislations/Budgetary issues
Health Promotion/Disease Prevention
Data & Research Issues impacting Indian Health
Provide technical assistance to NW tribes

5. HPV Immunization Portland Area clinics (Idaho, Oregon, Washington)
FY st Qtr: October 1, December 31, 2017
First
Second
Third
AI/AN Female
13-17
84.6%
62.9%
26.4%
AI/AN Male
79.9%
56.8%
23.1%
·         Girls 13 years old- there is a small increase in initiation and 14%  percentage point decrease in completion.
·         Boys 13 years old- there is again a small (4percentage point) increase in initiation and a 6.4% decrease in completion.
·         Girls there is a small increase in initiation and a 7 percentage point decrease in completion.
·         Boys there is no change in initiation and a drop of 5 percentage points in completion.
National Immunization Reporting System - IHPES Program
11/12/2018
Northwest Portland Area Indian Health Board

6. Northwest Portland Area Indian Health Board
HPV rates 13 years olds
2016
2017
2018
Girls 13 
(n=443)
(n=383)
(n=318)
       1 dose
82.4%
83.0%
84.6%
       2 dose
63.2%
64.2%
62.9%
       3 dose
39.1%
36.6%
26.4%
Boys 13
(n=458)
(n=390)
(n=359)
75.5%
80.0%
79.9%
52.0%
53.6%
56.8%
29.5%
29.0%
23.1%
·         Girls 13 years old- there is a small increase in initiation and 14%  percentage point decrease in completion.
·         Boys 13 years old- there is again a small (4percentage point) increase in initiation and a 6.4% decrease in completion.
·         Girls there is a small increase in initiation and a 7 percentage point decrease in completion.
·         Boys there is no change in initiation and a drop of 5 percentage points in completion.
National Immunization Reporting System - IHPES Program
Indian health performance evaluation system
11/12/2018
Northwest Portland Area Indian Health Board

7. Northwest Portland Area Indian Health Board
Immunization Rates
2016
2017
2018
Girls 13-17 
(n=2404)
(n=2071)
(n=1886)
       1 dose
85.4%
88.3%
87.1%
       2 dose
75.1%
78.2%
76.4%
       3 dose
60.5%
62.0%
53.0%
Boys 13-17 
(n=2258)
(n=1967)
(n=1813)
77.0%
84.6%
84.8%
59.6%
69.3%
70.0%
40.2%
51.4%
46.4%
·         Girls 13 years old- there is a small increase in initiation and 14%  percentage point decrease in completion.
·         Boys 13 years old- there is again a small (4percentage point) increase in initiation and a 6.4% decrease in completion.
·         Girls there is a small increase in initiation and a 7 percentage point decrease in completion.
·         Boys there is no change in initiation and a drop of 5 percentage points in completion.
National Immunization Reporting System - IHPES Program
11/12/2018
Northwest Portland Area Indian Health Board

8. Oregon Cervical Cancer Screening
2017 Oregon Tribes GPRA
4 Tribes aggregate BRFSS
2011 Oregon BRFSS AI/AN
2011 Oregon BRFSS NHW
Pap Test
61.2%
(60% - 75%)
Within past 2 years
75.7%
Within past 3 years
82.2%
11/12/2018
Northwest Portland Area Indian Health Board

9. Oregon Cervical Cancer Incidence 2008-2012
Race
Incidence
(per 100,000)
95% Confidence Interval
(Lower, Higher)
AI/AN
8.1
(4.2, 15.6)
NHW
6.7
(6.1, 7.3)
2.3% of AI/AN women’s cancers are diagnosed Cervical Cancer
11/12/2018
Northwest Portland Area Indian Health Board

10. Oregon Cervical Cancer Mortality 2008-2012
Race
Mortality
(per 100,000)
95% Confidence Interval
(Lower, Higher)
AI/AN
2.1
(0.4, 8.6)
NHW
1.8
( )
From Masters thesis OHSU 2013
64.2% of AI/AN Cervical Cancer patients are diagnosed with regional or distant stage
11/12/2018
Northwest Portland Area Indian Health Board

11. Northwest Portland Area Indian Health Board
National 5 year Cervical Cancer Survival (2017 Report to Nation)
Race
5 year Survival rate (%)
95% Confidence Interval
(Lower, Higher)
AI/AN
64.7
(55.9 to 72.2)
NHW
70.0
(69.0 to 70.9)
11/12/2018
Northwest Portland Area Indian Health Board

12. 2014 Federal Bureau of Prison’s expenditure: $6,400
NCAI proposed budget for 2018
2014 Federal Bureau of Prison’s expenditure: $6,400
Source: The Federal Bureau of Prisons’ Reimbursement Rates for Outside Medical Care, Evaluation and Inspections Division June 2016

13. And this year - activities
2018 January HPV webinar (25 registered)
Dr. Amanda Bruegl
2018 February HPV National Roundtable
2018 NTCCP HPV vaccination update
Dr. Allison Empy
Warm Springs HPV media update
2018 NTCCP tribal clinical update
HPV Michelle Berlin
Head and neck cancer presentation
Cancer screening
11/12/2018
Northwest Portland Area Indian Health Board

14. Northwest Portland Area Indian Health Board
NTCCP Activities
2017 Women’s Health NTCCP Coalition Meeting
Presentation on Screening
Screening Native Women
If you don’t get screened
AI/AN Presentation from BCCP outreach workers NARA/SPIPA
2017 April NTCCP Coalition Meeting
HPV materials disseminated at tribal clinical directors cancer update
Posters, provider education fact sheets,
Presentation on women’s cancer
27 PCP from 14 tribal clinics
Focus group from participants rating available HPV educational materials
Preference for locally developed fact sheets and posters
11/12/2018
Northwest Portland Area Indian Health Board

15. Community Clinical Linkage
Created environmental scan
Piloted
Community Clinical Linkage
Four interviews
Clinical presentation – Native Clinic
Dr. Brugel
Dr. Empy
11/12/2018
Northwest Portland Area Indian Health Board

16. Northwest Portland Area Indian Health Board
Findings
All doing immunizations
Following IHS immunization protocol
Focusing on strategies – back to school physicals
HPV standing orders in place at the clinic
Immunization package used – Electronic Health Record
Utilize state program – vaccine supplies in especially in the Urban area
11/12/2018
Northwest Portland Area Indian Health Board

17. Northwest Portland Area Indian Health Board
Findings
Reminders for shots – cards and calls
Utilizing community health nurse
Emphasize cancer prevention
Promoted as part of the immunization recommendations
Information provided in the clinic - parents
Sports camps – community events – back to school picnics
Community health has a close relationship with clinic
11/12/2018
Northwest Portland Area Indian Health Board

18. Northwest Portland Area Indian Health Board
Findings (continued)
Women’s health and WIC programs and head start
New medical director, very engaged in women’s health
Provide Immunization clinics
Parents and especially grandparents are skeptical of the shot
All but one have immunization coordinator
Utilize county coordinator
Rates are low – but small population
IHS and tribal clinic have relatively high rates for the first shot
Fall off on the second and third
11/12/2018
Northwest Portland Area Indian Health Board

19. Cultural issues with the HPV Vaccination
Don’t know enough
Afraid of side effects
Mistrust of medical system
Mistrust of federal government
Remember past of women being sterilized
(From focus group at Northwest Tribal Comprehensive Cancer Coalition Meeting in 2015)
11/12/2018
Northwest Portland Area Indian Health Board

20. NTCCP Tribal Coalition
Issues:
Parents and especially grandparents are skeptical of the shot
Need to emphasize cancer prevention
Community incident with patient fainting
Anxiety about pain or side effects of the injections
Lack of education materials
Apprehension of federal government
Remember past of women being sterilized
Patients’ distrust of the medical system
11/12/2018
Northwest Portland Area Indian Health Board

21. Northwest Portland Area Indian Health Board
Lessons Learned
NTCCP works in a three state area, one state is very inclusive
The state task group already reaches out to multiple staff at my organization
My target population is already showing good rates for immunizations
We really need to be able to focus on issues in individual clinics that we work with
We had good partners, the timing was challenging
We had the Clinical application coordinator, who is a pharmacist, the IRB coordinator, the comprehensive cancer director and specialist, OHSU, ACS, and NTCCP director is a member of the National HPV roundtable
In addition, it would be great to develop a media blitz, specific to our population and get that out
There is an abundant amount of resources; it is just assuring that the information is getting to the clinics and health educators on a regular basis
11/12/2018
Northwest Portland Area Indian Health Board

22. Northwest Portland Area Indian Health Board
Hope
In Summary, several tribes will hopefully benefit from our efforts, as the NTCCP we will continue to work with our tribes to increase HPV vaccinations in our tribal clinics
11/12/2018
Northwest Portland Area Indian Health Board

23. Northwest Portland Area Indian Health Board
NPAIHB Timeline
2006 October NTCC- HPV Vaccine - Thomas Becker, MD, PhD
2007 January NTCC- HPV Clinical Update - Thomas Becker, MD, PhD
2007 April NTCC - IHS, Tribal, and State HPV collaboration - Donnie Lee, MD, IHS
2007 October NTCC - HPV Clinical Update - Thomas Becker, MD, PhD
2008 April NTCC - Indian Health Service HPV Vaccine Update -Donnie Lee, MD, IHS
2008 – CDC funded HPV Parent Focus groups in 2 Urban and 3 Tribes
2009 – CDC AI/AN from 2008 focus groups
2010 February - HPV Clinical Update - Thomas Becker, MD, PhD
2011 May NTCC - Women’s Health Update - Michelle Berlin, MD, OHSU
11/12/2018
Northwest Portland Area Indian Health Board

24. Northwest Portland Area Indian Health Board
Time line continued
2012 October NTCU - Head and Neck Malignancies – Screening, Prevention and Treatment - Eric J. Dierks, MD, DMD, FACS
2014 January NTCC – HPV Vaccination Update – Clarice Charging, Area Immunization Coordinator
2015 NTCCP Director Invited National HPV Roundtable
2016
Contract with ACS via partnership with the CPCRN (OHSU) – Pharmacists providing HPV shots
11/12/2018
Northwest Portland Area Indian Health Board

25. Northwest Portland Area Indian Health Board
Time line continued
2017
Contract OHSU PRC
HPV environmental scans in tribal communities
Key informant interviews
Community / clinical linkages (Pharmacist, MCH Nurse, MA, FNP, Case manager)
Provider presentation – Dr’s Bruegl and Empy
Presentation on new guidelines for HPV
Efficacy
Cancer prevention
Role playing
11/12/2018
Northwest Portland Area Indian Health Board

26. Northwest Tribes Meet the Challenge
Cooking classes/healthy eating
Just Move It
Tribal cancer coalition
Women and Wellness
Lifestyle Intervention Classes
Breast Cancer Awareness Bingo
Colorectal Cancer Poker Walk
Pap-a-thon
Pink Paddle Project
Aerobics Video
Pink Shawl
Mother daughter tea/lunch
Golf tournament
Cancer awareness day
Cancer 101
Great American Smoke out
Men’s health day
Relay on the Rez

27. Northwest Tribes Meet the Challenge
Tribal health fair
Community gardening project – fresh produce, elders luncheon,
Men and women's wellness conference
Pink and blue party – biggest loser
Zumba fun and fitness night – cancer kab, smoothie station
Youth camp – skin cancer, tobacco physical activity, healthy eating
Youth prevention night “Traditional games”
Traditional food gathering classes – salad class, and preserving strawberries
Breathe free
Memorial day cancer walk “Shining light”

28. Northwest Portland Area Indian Health Board
Contact Information
Northwest Tribal Comprehensive Cancer Project Kerri Lopez (Tolowa), Project Director Eric Vinson (Cherokee), Project Coordinator Antoinette Aguirre (Navajo), Cancer Prevention Coordinator Tom Becker, MD, PhD, Medical Epidemiologist Phone:
11/12/2018
Northwest Portland Area Indian Health Board