National HPV Monitoring Program (IMPACT)

• 
  Project Lead
  Dr Dorothy Machalek

  dorothy.machalek@unimelb.edu.au

  View researcher's webpage

• 
  Head of Lab
  Dr Gerald Murray

  gerald.murray@unimelb.edu.au

  View researcher's webpage

Project Details

National HPV Monitoring Program (IMPACT)

The National HPV Monitoring Program (also called IMPACT), was established in 2014, as a collaboration between the Royal Women’s Hospital Centre for Women’s Infectious Diseases; The Kirby Institute at UNSW; Melbourne Sexual Health Centre; VCS Population Health (VCS Foundation); Cancer Council New South Wales; Menzies School of Population Health; Family Planning New South Wales; The University of Sydney; and The University of Melbourne. The program brings together internationally recognised epidemiologists, surveillance experts, sexual health physicians and statisticians from across Australia and is funded by the Australian Government Department of Health.

IMPACT aims to achieve timely evaluation of the National HPV Vaccination Program by (i) establishing a national sentinel surveillance system to enable the collection of specimens for HPV testing from priority populations and (ii) monitoring long term trends in HPV infection prevalence with linkage of data to HPV immunisation status.

The program draws on two mechanism of data collection including (i) collating data routinely collected in the renewed National Cervical Screening Program to obtain national level information on HPV infection prevalence among women participating in cervical screening and (ii) working with a national network of laboratory services to collect residual clinical specimens for HPV genotyping. The latter mechanism is targeted at women who are not yet eligible for cervical screening (i.e. under the age of 25 years), to provide timely evaluation of the switch to the nonavalent HPV vaccine. The laboratory network also serves as a framework for monitoring impact of the national HPV vaccination program among men who have sex with men, who are at greatly increased risk of HPV-associated anal cancer.

Researchers

Prof Suzanne Garland, Director

Dr Gerald Murray, Senior Research Fellow, Microbiologist

Dr Dorothy Machalek, Senior Research Fellow, Epidemiologist

Dr Monica Molano-Luque, Research Officer, Molecular Biologist

Ms Hannah Shilling, Project Coordinator

Ms Prisha Balgovind, Research Assistant

Collaborators

The Royal Women’s Hospital, Melbourne

School of Population and Global Health at The University of Melbourne University

Melbourne Sexual Health Centre Alfred Health

Murdoch Children’s Research Institute

The Kirby Institute at the University of New South Wales

VCS Foundation, Victorian Cytology Service

Cancer Research Division and C4 CRE at Cancer Council New South Wales

Menzies School of Health Research

Family Planning Victoria and New South Wales

The University of Sydney Department of Paediatrics and Child Health

Funding

Commonwealth Department of Health

Research Opportunities

This research project is available to Honours students to join as part of their thesis.
Please contact the Research Group Leader to discuss your options.

Research Outcomes

• A pilot study conducted utilising de-identified residual specimens from women aged 16-24 years submitted for chlamydia testing as a means of HPV infection surveillance found this to be a feasible method for surveillance. This method will be employed for ongoing surveillance among young Australia women and men who have sex with men.
• Low prevalence of quadrivalent vaccine targeted HPV types among young, largely unvaccinated, heterosexual Australian men has been identified in several cohorts, building evidence for herd protection effects achieved by the initial female-only vaccination program. Research continues into the impact of the universal vaccination program as vaccinated men age.
• Analysis of routine cervical screening data collected in NSW since the renewal of the National Cervical Screening Program found that oncogenic HPV was detectable in 8% of specimens. Repeat 12 month HPV testing was recommended for 5% of women and direct colposcopy for 3%
• Similarly, analyses of routine screening data collected in the first seven months of the renewed program in Victoria found that oncogenic HPV was detected in 7% of specimens, plus a low prevalence of vaccine targeted oncogenic types 16 and 18 at 2%. Prevalence peaked in the youngest screening age group (25-29 years of age)
• Prevalence of quadrivalent vaccine preventable HPV types (HPV6, 11, 16, 18) has declined by more than 90% within 9–12 years since the introduction of the National HPV Vaccination Program, with types detected in fewer than 2 in 100 women (<2%). In contrast, before program introduction nearly 1 in 7 women (15%) aged 18–35 years were infected with one or more quadrivalent vaccine preventable HPV type at any given time.

Research Publications

HPV Surveillance (last 5 years)

1. Chow EPF, Tabrizi S, Fairley CK, Wigan R, Machalek DA, Garland SM, Cornall A, Atchison S, Hocking JS, Bradshaw CS, Balgovind P, Murray G, Chen MY. Fall in human papillomavirus in young men who have sex with men after the implementation of gender-neutral HPV vaccination: a repeated cross-sectional study. Lancet Infectious Diseases (In Press).
2. Shilling H, Murray G, Brotherton JML, et al. Monitoring human papillomavirus prevalence among young Australian women undergoing routine chlamydia screening. Vaccine 2020;38(5):1186-93. doi: 10.1016/j.vaccine.2019.11.019 [published Online First: 2019/11/27]
3. Machalek DA, Roberts JM, Garland SM, et al. Routine cervical screening by primary HPV testing: early findings in the renewed National Cervical Screening Program. Med J Aust 2019;211(3):113-19. doi: 10.5694/mja2.50223
4. Chow EPF, Tabrizi SN, Fairley CK, et al. Prevalence of human papillomavirus in teenage heterosexual males following the implementation of female and male school-based vaccination in Australia: 2014-2017. Vaccine 2019;37(46):6907-14. doi: 10.1016/j.vaccine.2019.09.052 [published Online First: 2019/09/29]
5. Brotherton JM, Hawkes D, Sultana F, et al. Age-specific HPV prevalence among 116,052 women in Australia's renewed cervical screening program: A new tool for monitoring vaccine impact. Vaccine 2019;37(3):412-16. doi: 10.1016/j.vaccine.2018.11.075 [published Online First: 2018/12/16]
6. Machalek DA, Garland SM, Brotherton JML, et al. Very low prevalence of vaccine human papillomavirus types among 18- to 35-year old Australian women 9 years following implementation of vaccination. Journal of Infectious Diseases 2018;217(10):1590-600. doi: 10.1093/infdis/jiy075
7. Machalek DA, Chow EP, Garland SM, et al. Human Papillomavirus Prevalence in Unvaccinated Heterosexual Men After a National Female Vaccination Program. J Infect Dis 2017;215(2):202-08. doi: 10.1093/infdis/jiw530
8. Das R, Machalek DA, Molesworth EG, et al. Using Facebook to Recruit Young Australian Men Into a Cross-Sectional Human Papillomavirus Study. J Med Internet Res 2017;19(11):e389. doi: 10.2196/jmir.8739