Background and Context:
The Australian National Cervical Screening Program (NCSP 1991) has halved the incidence and mortality of cervical cancer. New scientific knowledge and new technologies including liquid based cytology, Human Papilloma Virus (HPV) testing and implementation of the National HPV Vaccination Program have led to an evidence–based review of the NCSP (Renewal). In April 2014 it was recommended to the Australian Government that a biennial Pap test for women 18 to 69 years of age be replaced with a primary HPV test every 5 years for both HPV vaccinated and unvaccinated women 25 to 74 years of age.
Aim:
To outline the Renewal process, recommendations and development of the implementation plan for managing substantial policy and practice change to a national screening program involving national, state and territory governments, multiple health care sectors, clinical disciplines and consumers.
Strategy/Tactics:
The aim of the Renewal is to ensure that all Australian women, HPV vaccinated and unvaccinated, have access to a cervical screening program that is acceptable, effective, efficient and based on current evidence.
Programme/Policy Process:
The Renewal:
o Assessed the evidence;
o Determined a cost-effective screening pathway;
o Investigated options for improved national data collection systems and registry functions to enable policy, planning, service delivery and quality management; and
o Assessed the feasibility and acceptability of the renewed program for women.
Evaluation of the evidence of the safety, clinical effectiveness and cost-effectiveness, is an integral part of the listing of new medical technologies and services on the Australian Medicare Benefits Schedule (MBS).
Outcomes/What was learned:
Changing policy and practice requires planning, governance, collaboration, coordination of multiple concurrent activities, risk management and communication. It also requires leadership, courage and commitment. This process may be applicable to future decisions about the use of emerging evidence and technologies in other established screening programs.