In 2006, a quadrivalent human papillomavirus (HPV) vaccine was licensed, and another vaccine may be licensed soon. Little is known about the practical considerations involved in designing and implementing cervical cancer prevention programmes that include vaccination as a primary means of prevention. Although the vaccine may ultimately be indicated for both males and females, young girls, or girls and women aged 9-25 years, will be the initial candidates for the vaccine. This paper describes avenues for service delivery of HPV vaccines and critical information gaps that must be bridged in order to inform future sexual and reproductive health programming. It proposes the role that the sexual and reproductive health community, together with immunization and cancer control programmes, could have in supporting the introduction of HPV vaccines within the context of current health systems. Voir page 62 le résumé en français. En la página 62 figura un resumen en español.
IntroductionCervical cancer is a gender-specific disease that disproportionately affects women in the lowest socioeconomic classes throughout the world. A metaanalysis of 57 studies revealed that there was an estimated 100% increased risk of invasive cervical cancer for women in low social class categories when compared with those in high social class categories; this difference reflects a lack of access to screening and treatment services.1 Likewise, these differences also occur between developed and developing countries, translating inequity in access to inequity in the quality services.In 2004, the 57th World Health Assembly adopted WHO's global repro--ductive health strategy, which identified five priority areas including "combating sexually transmitted infections"; the strategy also specifically addressed cer--vical cancer prevention.2 In addition, a resolution on cancer prevention and control was adopted by WHO's Mem--ber States, and a new vision and strategy
Ensuring access to HPV vaccines through integrated services: a reproductive health perspective
Objective
To determine the validity of data pertaining to hysterectomy in the Saskatchewan health care utilisation datafiles.
Design
Retrospective analysis of routinely collected data covering hospital discharge records and practitioner claims for reimbursement of services, together with a review of clinical charts.
Setting
Province of Saskatchewan, Canada.
Sample
All 1905 cases of hysterectomy in one calendar year for analysis of datafiles and a random sample of 227 clinical charts for review.
Method
Information in the hospitalisation datafile was validated through an external comparison with data extracted from a review of clinical charts, as well as an internal comparison with independent data from the practitioner claims file. Corresponding context data on drug use and performance of related procedures were also analysed.
Results
Concordance between hospital data and clinical charts was greater than 95% for those items of an administrative nature as well as type of hysterectomy and was around 85% for the diagnoses. When hospitalisation and practitioner claims data were compared, the concordance was 98% for type of hysterectomy but only 56% for diagnoses.
Conclusions
The agreement between hospital data and clinical charts was excellent. The concordance between hospitalisation and practitioner claims data was almost exact for type of hysterectomy, while discrepancies in diagnoses between these files were mostly explainable on the basis of accepted clinical practice. Saskatchewan health care utilisation datafiles provide a source of valid data for research and evaluation studies.
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