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C4 Projects

Explore some of the C4 projects currently underway that are contributing to the global elimination of cervical cancer. C4’s work is divided into three core streams based on the WHO three elimination pillars: 1) HPV Vaccination, 2) Screen, triage and treat, and 3) Increasing Access to Cervical Cancer Treatment; with some projects that integrate across all pillars.

ScreenEQUAL: Increasing cervical screening participation for people with intellectual disability

People with intellectual disability are often excluded from making decisions about whether to have a cervical screening test. This is because of many barriers including stigma and discrimination and non-inclusive screening information and healthcare practices. The ScreenEQUAL Project aims to improve informed decision-making about cervical screening by people with intellectual disability. We are co-producing an accessible information resource to increase people’s knowledge about screening including the option of self-collection. We are also co-producing accompanying materials to help families and support people build their skills and knowledge about how to support people with intellectual to have cervical screening. To optimise people’s experience with cervical screening in primary care, we are co-producing trauma-informed training materials for GPs and nurses who work with this group.

Screen Equal logo
Supporting Choice for Cervical Screening logo

Supporting Choice

Supporting Choice for Cervical Screening is a collaborative research project that aims to generate the evidence about how the choice for self-collection can be implemented, across a range of services and settings, in ways that ensure equitable access and increased participation for people who currently experience barriers to cervical screening.
Supporting Choice is co-led by Dr Claire Nightingale (The University of Melbourne) and Associate Professor Megan Smith (the Daffodil Centre: a partnership between Cancer Council NSW and The University of Sydney), with colleagues from The Kirby Institute (UNSW) and other C4 partners.
We are working with members of the health care workforce, and with members of priority under-screened communities, to understand their experiences and proposed solutions to improving screening access. Bringing these understandings together, we will work to jointly design, test and evaluate solutions.
Supporting Choice has a specific focus on improving access to cervical screening for women and other people with a cervix who are from refugee and asylum seeker backgrounds, live with disability, are members of the LGBTQI+ community and/or from a Pacific or South Sea Islander background.
For more information visit Supporting Choice for Cervical Screening (unimelb.edu.au)

EPICC

The Elimination Partnership in the Indo-Pacific for Cervical Cancer (EPICC) is the largest ever initiative of its kind, leveraging Australian, international and in-country partner expertise to accelerate the World Health Organisation’s strategy for the elimination of cervical cancer across 8 countries in the Indo-Pacific region. EPICC is made possible by a $14.5M regional aid grant from the Australian Government Department of Foreign Affairs and Trade (DFAT) through the Partnerships for a Healthy Region initiative. It was built on the successes of the Minderoo Foundation funded Eliminate Cervical Cancer in the Western Pacific (ECCWP) project in the Western Highlands province of PNG and Vanuatu, along with the parallel successes from Program Rose in Malaysia. EPICC will leverage these longstanding local, regional and international partnerships, to accelerate the elimination of cervical cancer in the Indo-Pacific region, coordinated with other Australian Government-funded and international efforts. EPICC is currently a four-year program that will be co-designed with partner governments to undertake a range of cervical cancer control activities in the Indo-Pacific region with a focus on capacity building, sustainability, and equity.

COMPASS

The Compass Trial is a key piece of Australian research supporting the National Cervical Screening Program. Compass is the largest clinical trial in Australia, conducted by the Australian Centre for the Prevention of Cervical Cancer and Cancer Council NSW. The roll out of the Compass pilot has already delivered major benefits to the Department of Health and the National Cancer Screening Program (NCSP) by informing the implementation of the renewed screening pathway in December 2017, including laboratory and registry processes. It is expected to inform future changes to the NCSP by confirming that the HPV test is a superior screening method and to assess different ways of deciding which women need further investigation.

This is particularly important to understand in the context of Australia’s National HPV Vaccination Program, where vaccinated and unvaccinated cohorts are participating in cervical screening. The trial will answer many different questions for the program around demand, the pathway and safety. Compass recruitment closed in January 2020. The Australian Centre for the Prevention of Cervical Cancer has continued to operate the Compass Register to support healthcare providers and the 76,000 trial participants until the conclusion of the Compass Trial. The trial is co-led by Prof Marion Saville and Prof Karen Canfell.

The

HPV Partnership Project

The HPV Partnership Project is a National Health and Medical Research Council (NHMRC) grant (APP1132344): ‘Identifying and addressing gaps in the national adolescent HPV vaccination program’. The HPV Partnership Project funding scheme aims to support translational or evaluation research that requires formalised collaboration between research institutions and partners involved in policy or practice, such as government, private and non-government sector organisations, or community and consumer groups.

The policy and practice partners in the HPV Partnership Project are the Departments of Health in New South Wales, Tasmania and Western Australia, and the Australian Centre for the Prevention of Cervical Cancer, which formerly operated the National HPV Vaccination Program Register. The grant is led by Professor Rebecca Guy and involves nine additional chief investigators and 10 associate investigators.

ECCWP

The Eliminate Cervical Cancer in the Western Pacific Project (ECCWP) is a first-of-its-kind humanitarian and research effort to eliminate cervical cancer in the Western Pacific. The project aligns to the World Health Organization (WHO) strategy to eliminate cervical cancer as a public health problem worldwide by the end of the century, through a ‘triple-intervention’ approach, which sets out simple targets to place all countries on the path toward elimination by 2030. Throughout the project, the partners will:

  • Work with health officials in Papua New Guinea and Vanuatu, leveraging opportunities to build and prioritise existing health services.
  • Fast-track HPV vaccines for girls and cervical screening for women in Papua New Guinea and Vanuatu and deliver training and equipment to build healthcare capacity.
  • The Australian research arm will conduct modelling and analysis to inform the most efficient and effective ways to implement and then expand the initiative.

This project is jointly led by Prof Karen Canfell, Prof Andrew Vallely, Prof Marion Saville, and A/Prof Deborah Bateson.

Piloting a surveillance system for the prospective collection and HPV typing of cervical cancers in Australia

HPV Pilot

The HPV Pilot is developing a pilot cervical cancer HPV typing surveillance system for monitoring the impact of HPV vaccination and cervical screening on cervical cancer in Australia. In this pilot, pathologists at public laboratories diagnosing cervical cancer will send de-identified tissue samples from cervical cancer cases for HPV typing. If HPV is not detected, or more than one type is detected, laser capture microdissection and/or research-based HPV assays will be used to attempt to identify the HPV in the cancer. The results of this study will provide a framework for an ongoing system for the long-term monitoring of causal HPV genotypes in cervical cancers that can be easily integrated into routine practice across laboratories in Australia. The HPV Pilot is led by Prof Julia Brotherton.

STORIES

The STakeholder Opinions of Renewal Implementation and Experiences Study (STORIES) was a national consultation with stakeholders and partners involved in delivering the National Cervical Screening Program. Semi-structured interviews were conducted in 2019 with 49 stakeholders, with the aim of documenting and understanding their implementation experiences. This study aims to identify barriers and facilitators to the implementation of the renewed program and provide insights to inform the ongoing implementation of the program and for other countries considering a transition to HPV based screening. STORIES is led by Prof Julia Brotherton.

New Methods for

Detecting Disease in HPV Positive Women

Oncogenic HPV-based cervical screening benefits from triage strategies to identify women who have underlying high-grade squamous intraepithelial lesions (HSIL). Molecular markers, such as host and viral DNA methylation, HPV typing and E6/E7 mRNA are a promising option. We are working in the detection of these promising markers and in the discovering of new biomarkers for the detection of HSIL among hrHPV positive women by using self-collected and clinician collected samples. We are also working in the development of new methodologies for their possible implementation at point of care in Papua New Guinea and other countries.