Facilitating uptake of cervical screening among Indigenous women to achieve equitable and timely elimination of cervical cancer

In November 2020, the World Health Organisation (WHO) launched a strategy for the global elimination of cervical cancer. In order to achieve elimination, action is required on three fronts: vaccination, cervical screening, and treatment. The WHO elimination strategy sets targets to be reached by 2030 for vaccination (90% of girls), cervical screening (70% twice-lifetime using HPV testing) and treatment (90% of identified disease). Countries like Australia, with well-established screening programs and high HPV vaccine uptake, are well placed to reach elimination at the national level, but given this is a global strategy, there is particular need to ensure that targets are met and timely elimination is achieved amongst all groups within the population. In Australia, a critical disparity exists for Indigenous Australian women, who experience much higher rates of cervical cancer, primarily due to lower screening participation. In terms of Australia's performance against the WHO 2030 targets, among Indigenous women, Australia currently meets the HPV vaccination target (although course completion is lower for Indigenous people), but does not meet the targets for screening or treatment. Cervical screening coverage is substantially lower in Indigenous women than in non-Indigenous women, and time to clinical investigation is longer. Therefore, in order to achieve equitable and timely elimination among Indigenous women in Australia, there is an urgent need to increase screening participation, including completing the whole clinical pathway.