Expressions of Intent for International Polar Year 2007-2008 Activities

Expression of Interest Details

PROPOSAL INFORMATION

Prevalence of Human Papillomavirus Infection and Cervical Dysplasia in the North West Territories  (Prevalence of HPV Infection and Cervical Dysplasia in the NWT)

Outline
In Canada, the high incidence and mortality rate of cervical cancer in Aboriginal populations of the Northwest Territories (NWT) has led to concerns about current screening methods. Recent reports in the literature have indicated that the Pap test is a less than ideal tool for screening for cancer of the cervix and this has generated interest in the potential for incorporating Human Papillomavirus (HPV) DNA testing into the present screening program. There is currently not a lot of information on the prevalence of HPV infection in the NWT which has the greatest number of Aboriginal communities in Canada. The objectives of the study are: 1. Determine the prevalence of type specific oncogenic HPV infection and cervical dysplasia (precursor lesion) in women of the NWT 2. Explore the association between type specific oncogenic HPV infection and cervical dysplasia in Northern Canada and its sub-populations 3. Identify the sub-types of HPV infection associated with cervical dysplasias in the sub-populations of the NWT 4. Provide scientific evidence for policy makers and local public health workers in NWT to plan and implement more effective cancer control programs Women over the age of 15 in the NWT who attend routine clinics for Pap smears will be invited to participate in this cross-sectional study. They will be asked to complete a consent form indicating that they have understood the nature of the study. The procedure for sample collection will be incorporated into the routine Pap testing done by physicians or community health nurses. Data collected will consist of cervical samples for HPV testing, socio-demographic information to analyse prevalence of type specific HPV, relative risk of HPV and cervical dysplasia, the attributable risk fraction of HPV infection and other risk measures. Conducting a study on the prevalence of HPV in a region that is known to experience a high rate of cervical cancer, can potentially be of great public health importance. More effective cervical cancer screening programs can be developed with the use of HPV DNA testing in combination with the conventional Pap smear testing. This research can potentially serve to integrate and facilitate measures to help accelerate the application of a new genetic technology into public heath and thus address the high incidence rate of cervical cancer.

What significant advance(s) in relation to the IPY themes and targets can be anticipated from this project?
The study has potential to make important contributions to our understanding and knowledge of HPV prevalence in women living in the NWT, specifically in the communities of Hay River, Fort Smith, Inuvik and Yellowknife. Additionally, the results may be useful in developing strategies aimed at preventing HPV infection and thereby reducing the burden of illness associated with high risk HPV infection. Conducting a study on the prevalence of HPV in regions that are known to experience a high rate of cervical cancer, can potentially be of great public health importance. More effective cervical cancer screening programs can be developed with the use of HPV testing in combination with the conventional Pap smear testing. This study can potentially serve to integrate and facilitate measures to help accelerate the application of a new genetic technology into public health. It is anticipated that with the widespread use of the HPV DNA test, that the total number of Pap smears and subsequent colposcopies will be reduced thus saving the provincial/territorial and federal governments resources that can be allocated to improving programs. This study is expected to demonstrate that more effective cervical cancer screening programs can be developed with the use of HPV testing in combination with the conventional Pap smear testing. The proposed study has received international endorsement as a sub part of IPY Joint Committee endorsed full coordinating IPY proposal the "Arctic Human Health Initiative". The study has elements in common with a study from Denmark entitled: "The burden of infectious diseases in Green-land-means of evaluation and reduction." Discussions regarding an international collaboration on HPV prevalence in northern Arctic communities have been initiated.

What international collaboration is involved in this project?
There is agreement in principle that an international collaboration on HPV prevalence in northern Arctic communities is possible. The proposed project will be in collaboration with a project on infectious diseases to be conducted by investigators in Denmark. Development of a common protocol will be pursued in order to ensure that results between study populations are comparable and generalizable to other Arctic communities.

FIELD ACTIVITY DETAILS

Geographical location(s) for the proposed field activities:
The research will take place in the Northwest Territories. The areas that are being considered are: 1. Fort Smith, population 2,185; 2. Hay River, population 3,510; 3. Inuvik, population 3,451; 4. Yellowknife, population 16,541.

Approximate timeframe(s) for proposed field activities:
Arctic: 01/07 – 02/07      02/07 – 10/08      10/ 08– 02/09
Antarctic: n/a

Significant facilities will be required for this project:
The study will require the assistance of a northern community coordinator whose responsibility will be to train northern physicians and community health nurses and research assistants in the research protocol, address any concerns that potential participants may have about the study and to ensure that data is collected and stored in accordance with the IPY guidelines. A northern research assistant will be necessary to explain the purpose of the research, the Pap smear procedure and issue informed consent forms to participants. Office space will be required for the coordinator and for the research assistant. A secure facility for the storage of questionnaires, consent forms computers and laboratory supplies is required. A boardroom is necessary for meetings with research personnel and collaborators etc. A facility such as the Dyna Care Kasper Laboratory in Edmonton is required to analyse the Pap smears. Resources pertaining to this study can be shared with other projects that have a similar research protocol.

Will the project leave a legacy of infrastructure?
The HPV research provides the opportunity for the next generation of polar researchers to continue investigations on HPV and other sexually transmitted agents. Surveillance mechanisms could be established in order to monitor the incidence and prevalence of them. This study provides the opportunity for northern research assistants to actively participate in research that will make a difference to the health of women in their community. There will be future opportunity for northern community health professionals to develop prevention strategies primarily targeted towards young women who are sexually active since HPV is a sexually transmitted agent. These strategies could reduce the burden of illness associated with high risk HPV infection. In the future, more effective cancer screening programs can be developed by northern health professionals with the use of HPV testing in combination with the conventional Pap smear testing. Not only will this improve the health and well-being of northern women but will also save the government of the NWT resources that can be allocated to developing programs targeted at improving the health of women in the north. A study such as this has the potential to build community capacity and provides the opportunity for new collaborations nationally and internationally. Once IPY funding has ended, discussions will be held with northern community health professionals regarding yearly monitoring the incidence and prevalence of HPV infection. This may require that equipment from this study remain at a central location for future use.

How is it envisaged that the required logistic support will be secured?
Consortium
Another national polar operator
National agency
Other sources of support

Has the project been "endorsed" at a national or international level?
Yes - The project has been endorsed at the international level as a sub part of IPY Joint Committee endorsed full coordinating IPY proposal number 167 the “Artic Human Health Initiative”.

PROJECT MANAGEMENT AND STRUCTURE

Is the project a short-term expansion (over the IPY 2007-2008 timeframe) of an existing plan, programme or initiative or is it a new autonomous proposal?


The HPV project will be a component of the Artic Human Health Initiative and has elements in common with Denmark EoI #1107 “The burden of infectious diseases in Greenland-means of evaluation and reduction”.

How will the project be organised and managed?
The project will be managed in partnership with the Government of the NWT, local health authorities, community representatives and collaborators. Contact will be made with the coordinating Arctic Human Health Initiative under which the current proposal fits, in order to discuss a management plan. The study will require the assistance of a northern community coordinator whose responsibility will be to train northern physicians and community health nurses and research assistants in the research protocol, address any concerns that potential participants may have about the study and to ensure that data, is collected and stored in accordance with the IPY guidelines. The coordinator will consult with the principle investigator on issues that may arise from the study.

What are the initial plans of the project for addressing the education, outreach and communication issues outlined in the Framework document?
Discussions about the HPV study were held with representatives of National organizations and Northern communities to address the research protocol, and dissemination strategy. Research plans will be communicated through Northern representatives via teleconference calls and face-to-face consultations. The results of this study can lead to increased community awareness about the importance of cervical cancer and the presence of a simple preventive measure – the Pap smear test. Moreover, the study can lead to a review of current PAP test screening schedules and procedures which can result in better continuity of care in the north. The results of the study will be first released to the Northern communities affected by HPV and cervical dysplasia and then to the South. An information session about the study results will be provided to Northern communities and questions will be addressed. Discussions will be held with the Northern organizations to determine the final format for translating and communicating the results in a format appropriate for Northern communities. Permission will be obtained from community leaders in order to communicate the research results to national and international fora. After approval has been obtained for release of the study results, scientific reports on the prevalence of HPV, types of HPV, cervical dysplasia and the association of HPV and cervical dysplasia in Northern communities will be produced. A policy report will be written on the cost-benefit of incorporating an HPV testing component in the current cervical cancer screening and its impact on the local communities.

What are the initial plans of the project to address data management issues (as outlined in the Framework document?
The data management plan will follow the guidelines and principles of the IPY data policy pertaining to traditional knowledge and cultural heritage, free and unrestricted exchange, timely exchange, quality control preservation, easy access, use of existing national and international mechanisms and centres, reporting requirements and acknowledgement. The principal investigator and coordinator associated with this study will discuss the data policy with the activity lead in order to support interaction across projects and early availability of information to the Northern community. Moreover since there will be international collaboration on this study, consistency in the protocol/collection of data will be closely followed. HPV prevalence, HPV sub-type prevalence, relative risk of HPV and cervical dysplasia, the attributable risk fraction of HPV infection and other risk measures will be calculated.

How is it proposed to fund the project?
Funding will be obtained through national funding agencies.

Is there additional information you wish to provide?
None

PROPOSER DETAILS

Dr Judy Niles
Public Health Agency of Canada
120 Colonnade Road, Ottawa, Ontario
K1A 0K9
Canada

Tel: 613-952-9418
Mobile: no
Fax: 613-941-2057
Email:

Other project members and their affiliation