HealthCare Sample Paper

Question

APA style 9-page research paper on the Human Papillomavirus (HPV) policy. Minimum of 3 references. Write a paper exploring the planning, implementation, and evaluation that went into the policy

Title: Human Papillomavirus (HPV) Policy

Answer

Contents

Introduction. 2

Different health policies or programs for HPV in the U.S. 3

Vaccination. 3

Screening. 5

Analysis of the vaccination policy adopted by the Center for Disease Control and Prevention (CDC) in the U.S  7

Planning. 7

Implementation. 7

Evaluation. 9

Conclusion. 10

References. 11

Introduction

Human Papillomavirus (HPV) is the most commonly occurring sexually transmitted virus in the U.S. It is estimated that at least 50% of all sexually active people will contract genital HPV at one point in their lives. HPV is a term used to refer to a group of viruses that number more than 100 different types or strains.

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More than thirty of these viruses are transmitted sexually. They can infect the genitals of both men and women, whereby they affect the skin of the penis and the vulva. Other areas that can be affected include the linings of the vagina, the anus, rectum, and cervix. Most people who contract HPV do not have any symptoms and they clear the infections on their own.

However, some high-risk HPV viruses may cause Pap test abnormalities. They are often considered ‘high-risk’ because they can cause the cancer of the cervix, vagina, vulva, penis or anus. Others are referred to as ‘low-risk’ types since they may cause only mild genital warts or Pap test abnormalities. Genital warts are cauliflower-shaped, multiple bumps or growths that appear around the genital areas.

Currently, 20 million Americans are infected with HPV. By the time they attain the age of 50, 80% of all American women will have contracted HPV. Every year, about 6.2 million Americans contract a new strain of genital HPV infection. This infection is primarily through genital contact. Most of the infections do not have any signs and symptoms. For this reason, most infected people are not aware of their HPV status, yet they can easily transmit this virus to a sexual partner.

            HPV diagnosis is often done primarily through abnormal Pap tests. A Pap test is the most commonly tool for determining the presence of pre-cancerous changes within the cervix. Most of these changes often relate to presence of HPV. Additionally a specific test is often available for detecting the HPV DNA of women. The test can be used in women who have mild Pap test abnormalities. It can also be used among women aged over 30 at the time when Pap testing is done. HPA DNA testing is helpful in enabling healthcare providers to determine whether further testing and treatment are needed.

            There is a relationship between HPV and cervical cancer. It is estimated that between 10 and 30 types of genital HPV can bring about, in rare cases, the development of cervical cancer.Research shows that for 90 percent of women, cervical HPV infection becomes impossible to detect within two years (Issel, 2009).Although only a small percentage of women suffer from persistent infection, the main risk factor associated with cervical cancer is persistent infection with any of the many known ‘high-risk’ strains of HPV.

Different health policies or programs for HPV in the U.S

Vaccination

Vaccination is one of the programs being used by the Center for Disease Control and Prevention (CDC) in the US in the fight against HPV infections. Vaccinations are commonly used as a measure of combating cervical cancer. The number of women who are being screened for cervical cancer continues to increase. Studies have been done to compare different phenomena surrounding the facilitation of vaccination-related activities. Comparisons tend to be made for purposes of determining the economic and social effects of vaccination against HPV.

The results of using vaccination alone appear to differ from those derived when conventional cytological screening only is adopted. Sometimes, vaccination tends to be followed by screening. Other variables that are often considered include screening intervals and the different approaches among people with high-risk viruses compared to those with low-risk viruses. Age is also a crucial variable in determining the screening and vaccination patterns that are adopted in various state and federal programs.

            Vaccination for HPV can be a cost-effective intervention when it is combined with screening. However, it depends largely on how effectiveness is maintained during the ages when peak oncogenic HPC incidences are recorded. A top priority should be on identification of the optimal age when vaccination measures are most efficient. Incidentally, not much research has been done to determine the age intervals at which vaccination against HPV work best (Kulasingam& Myers, 2003).

            The cost-effectiveness of using prophylactic vaccination papillomavirus types 16 and 18 remains a critical consideration for various guidelines for immunization within the United States. Both epidemiological and demographic data needs to be assessed in order to determine the transmission patterns as well as carcinogenesis of HPV-related cervical cancer incidences.

The economic and health outcomes of a vaccination catch-program against HPV in the U.S depend largely on the success of simultaneous efforts being made to avert HPV-related cancers. The duration of immunity determines the frequency with which girls and women of various ages are exposed to immunization programs.

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            The cost of vaccination increases significantly if the vaccines used fail to provide life-long immunity to communities. Compared to the current screening practice, the vaccination practice in the U.S is such that the cost-effectiveness ratio per quality-adjusted life-year (QALY) among 12-year-old girls is $43,600. On the basis of baseline assumptions, catch-up programs for 18-year-old girls bring about a cost-effectiveness ratio of $97,300 per QALY.

            The cost-effectiveness ratios for different vaccination strategies become more favorable whenever benefits of averting many other health conditions are included or if screening is delayed and performed at much less frequent intervals. However, screening is done, the tests used need to be sensitive in order to enhance their accuracy. In the current screening program in the U.S, girls are screened more frequently during adulthood than during preadolescence and adolescence. Initial catch-up efforts often take shape when the girls’ average age is 21 years.

Screening

Not much is known about the awareness of HPV DNA testing among physicians in the U.S. As newly-approved vaccines continue to enter into the U.S healthcare system, the need for primary health physicians to understand the importance of HPV DNA testing and screening is being felt in the country’s health sector. Today, female community-based physicians are twice as likely to carry out HPV screening in their patients compared to their male counterparts.

            The intention by most physicians to use HPV vaccine once it has been approved by the FDA is clear by their willingness to make follow up medical procedures after carrying out screening tests. Physicians who are familiar with screening procedures also tend to be familiar with the vaccines that are commonly used to control the HPV virus in communities.

Research shows that very few people who have undergone the HPV DNA screening procedure have been told about their level of risk to HPV infection (Lewis, Packard & Lewis, 2006). This could be an indication of a lack of awareness of logistical issues relating to the viruses by the majority of physicians in the U.S. women who have undertaken Pap tests in the past, tend to show strong intentions of obtaining a vaccination compared to women who have never undertaken such tests.

            In the US, both HPV and Pap tests are recommended for all women and they can be done by primary health physicians. Women can also take Free and low-cost Pap tests through the National Breast and Cervical Cancer Early Detection Program, especially those who are on a low-cost health insurance policy or with no health insurance policy at all.

            The availability of Pap tests has resulted in a reduction in cervical cancer rates despite high HPV infection rates. Pap tests are able to detect not just the early-stage cervical cancer, which can be treated easily, but also the precancerous changes in cervical cells, referred to as cervical dysplasia. The tests enable physicians to remove all the affected tissues long before the setting in of invasive cancer. Pap tests were introduced into the US in the 1950s.

            The current screening processes are in need of revision in order to increase the efficiency of vaccination in terms of cost-effectiveness. Just like in vaccination, screening should be targeted primarily towards young adolescent girls as well as ‘catch-up’ efforts on women who are young than 21 years.

            Traditionally, the prevention of cervical cancer in the U.S through the Pap smear and HPV DNA test is recommended annually or biennially among all sexually-active women. However, many issues relating to screening arise with regard to the ideal time to vaccinate females, various target groups for different catch-up programs and the changes that should be done to screening practices.

            Many uncertain scenarios impact on the effectiveness of the policies that are adopted in dealing with HPV in the U.S. such scenarios includes the duration of vaccine protection and whether a booster dose is needed. The issue of whether the vaccine in question will also prevent infections relating to other HPV types arises. The policies are also influenced by questions on what may occur to cancer rates if women changed their existing screening practices once they have been vaccinated.

Analysis of the vaccination policy adopted by the Center for Disease Control and Prevention (CDC) in the U.S

Planning

The nature of planning in current vaccination policy dwells around efficiency and cost-effectiveness. Emphasis tends to be on pursuing a catch-up program among girls between the ages of 13 and 18. Within this gap, the vaccination efforts are generally considered cost-effective. However, uncertainty still reigns on whether such a program can remain cost-effectiveness if the program was extended to women aged 21 years. This depends on whether this vaccine will be proven to be effective in preventing other cancers that are caused by HPV-16 and -18.

Currently, recommendations are against use of the vaccine among women aged about 26 since its effectiveness among sexually active people is rather low, not to mention the expensive nature of such an undertaking. Currently, the recommendations of the vaccination policy clearly indicate routine vaccination of girls between 11 and 12 years and catch-up vaccination programs for all girls and women aged between 13 and 26.

Implementation

            There is no any absolute criterion for dictating whether public health intervention or a vaccine in the U.S is cost-effective. Most policymakers in the U.S, though, are of the opinion that all interventions with a cost-effectiveness of less than $50,000 per each QALY gained are a good value for money (Taira, Neukermans& Sanders, 2004). Vaccination of 12-year-olds totals up to a figure that is less than this threshold, while that girls who are in their mid and late 20s is on the higher side of the threshold.

            The implementation of the vaccination policy may be affected by the availability of future information. If information accessed in the future indicates that the protection of the vaccine does not last, the program can turn out to be a cost-ineffective health measure. A similar outcome can be derived in case of unexpected increase in other cancer-causing HPV types, which are not included in the vaccine.

            Throughout the U.S, state legislatures continue to scramble to respond to the presence of the HPV vaccine named Gardasil and the likely entry of Cervarix, a yet-to-be-approved vaccine from GlaxoSmithKline. The latter vaccine has been proven to be effective in prevention of infection with HPV types that cause 70 percent of all cervical cancer cases.

            The ACIP (Advisory Committee on Immunization Practices) at the Center for Disease Control and Prevention (CDC) has already voted unanimously in recommendation of use of Cervarix among girls aged between 11 and 12 years. Additionally, the CDC added Garddasil to the Vaccines for Children Program, a policy framework that offers free immunizations to undeserved and impoverished children.

Despite many concerted efforts at the federal level, access to these vaccines appears to have turned into a political question rather than a public health one. The concern of high cost of vaccines poses a genuine concern to physicians, patients and insurers. Instead of issues of cost being highlighted, focus has turned on the purported interference in people’s sexual mores and family lives. This concern has generated many political efforts to forestall the process of creating a mandated federal-based vaccination program. Legislative maneuvering has been experienced in Georgia and Florida, where opposition to mandated vaccination to all sixth grade girls reflects the need to accept the realities of today’s teenage sexualities. The main issue of contention was the question of parental discretion to opt out of the suggested mandatory vaccination school-based programs.

The constitutionality of these vaccination mandates tends to be premised on the extent to which the risk-balance is reasonable, the extent of intrusion into one’s personal autonomy, and most importantly, genuine public health necessity. Whenever claims of state paternalism are made, the noble goal of achieving community protection loses justification. A third force that alters this balance is the parental option of refusing this vaccination without refusing the child a right to attend school.

            Opt-in programs require affirmative efforts by parents. Therefore, it misses all the children whose parents forget to, or do not want to opt-in. on the other hand, an opt-out approach drastically increases the vaccination rates among all children whose parents do not have any real objection to the program while at the same time preserving the autonomy of the parent.

Evaluation

            The efforts made by the CDC have been marked by, among other issues, resistance. Opposition to HPV vaccines in the US heralds a new chapter in the country’s resistance to vaccination. In some levels, it is a reflection of a growing trend whereby parents refuse to accept vaccines on the false perception that many of them are riskier than the diseases they are meant to prevent.

In cases of resistance from parents, pediatricians concentrate on the role of educating and counseling families who object to HPV vaccination. This appears to be the best they can do because the risks associated with being unvaccinated are rarely so substantial as to make the refusal tantamount to medical neglect.

            The vaccination program of CDC, it seems is more effective than any abstinence-only approach that has been adopted in the US. Experience shows that no abstinence-only approach can delay the sexual initiation age, nor can they decrease the frequency and number of sexual encounters. According to estimates by the CDC, although only 13% of all American girls are sexually experience by the age of 15, this number increases to 43% by the time they are aged 17, and 70% for all 19 year-old girls. On the basis of these statistics, school-based vaccination programs are extremely crucial for purposes of reaching out to those at the highest risk of contracting STDs. 

Conclusion

            In summary, both screening and vaccination programs are critical elements of control measures against Human Papillomavirus (HPV) in the US. Through screening and vaccination, the rate of HPV infection has dropped drastically in recent years. This essay has focused on the process of planning, implementing and evaluating the effectiveness of vaccination program initiated by CDC.

            Although it is difficult to determine the exact nature of effectiveness of vaccination because of information that may become available in the future regarding the vaccination’s efficacy, girls aged between 12 and 18 record the higher level of efficiency in the use of HPV vaccines. However, medical experts recommend the extension of the program to cover girls and women aged up to 26 years. This is a necessary catch-up measure of reducing the spread of the HPV strains that cause cervical cancer. The culture of resistance to vaccination in the US needs to be addressed through such programs as civic education and creation awareness on the dangers of young girls not taking HPV vaccines, particularly the risk of cervical cancer.

References

Issel, L. (2009) Health program planning and evaluation: a practical, systematic approach for Community Health, London: Routledge.

Kulasingam, S. & Myers, E. (2003) Potential Health and Economic Impact of Adding a Human Papillomavirus Vaccine to Screening Programs, JAMA. 290(5), 781-789.

Lewis, J., Packard, T. & Lewis, M. (2006).  Management of Human Service Programs (4th Ed.). Belmont, CA:  Brooks/Cole Cengage Learning.

Taira, A.  Neukermans, C. & Sanders, G. (2004) Evaluating Human PapillomavirusVaccination Programs, Emerging Infectious Diseases, 10(11), 1915-1923.

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