Search

There is a pressing need for greater understanding and focus on cancer survivorship and informal cancer caring of trans people (binary and non-binary), across tumor types, to inform culturally safe trans inclusive cancer information and care. This qualitative study, part of the mixed methods Out with Cancer project, examined experiences of trans embodiment and identity after cancer diagnosis and treatment. We drew on open-ended survey responses from 63 trans cancer survivors and 23 trans cancer carers, as well as interviews and a photo-elicitation activity with a subset of 22 participants (15 cancer survivors, 7 cancer carers). Reflexive thematic analysis identified three themes: Cancer enhances trans embodiment, through experiences of gender euphoria following cancer treatment, and acceleration of decisions about gender affirmation; cancer erases or inhibits gender affirmation; trans embodiment is invisible or pathologized in cancer care. These findings demonstrate that trans embodiment and identity, as well as the process of gender affirmation, may be disrupted by cancer or informal cancer caring. Conversely, cancer and cancer treatment can positively impact the embodied identity and lives of trans people, despite the anxiety and strain of negotiating medical procedures. However, if healthcare professionals operate within a cis-heteronormative framework and do not understand the meaning of embodied change following cancer treatment for trans individuals, these positive benefits may not be realized.

Children’s sexuality education continues to be plagued with tensions and controversies. In consequence, children’s access to sexuality education is severely compromised, especially in terms of the time dedicated to this topic, the content addressed, how it is taught and by whom. Based on a study of 342 Australian parents of primary school aged children we explore: (i) parents’ perceptions of the relevance and importance of sexuality education to their primary school aged children and the discourses that inform their perspectives; (ii) parents’ views on who should be responsible for the sexuality education of young children; (iii) whether there are certain aspects of sexuality education considered more appropriate for the family to address with children; and (iv) what the implications of these findings are for sexuality education policy and practice in Australian primary schooling. Despite the controversial nature of the topic, the majority of parents in this study believed sexuality education was relevant and important to primary school children and that it should be a collaborative approach between families and schools. However, some parents/carers acknowledged that while that they believed that some topics should only be addressed at home they also indicated that this often does not happen.

BackgroundSchools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake.MethodsInitiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015-2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25thpercentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage.ResultsMedian initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates.ConclusionThis study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage.

Sport settings have long been documented as exclusionary environments for sexuality and gender diverse (SAGD) people and a key location of discrimination. Sport is associated with well-being, and i...

Key Points Question Does a human papillomavirus (HPV) vaccination intervention in the school setting improve adolescent psychosocial outcomes? Findings In this analysis of secondary outcomes of a cluster randomized trial and qualitative evaluation of an education and logistical intervention (HPV.edu) to improve acceptability of HPV vaccination in 40 schools (6967 adolescents), the mean score for adolescent involvement in decision-making was significantly higher in the intervention group than in the control group. There were also small, significant differences in favor of the intervention group with respect to adolescents’ vaccination-related anxiety and self-efficacy scores, measured before each of the 3 vaccine doses. Meaning An HPV vaccination intervention implemented in schools improved psychosocial vaccine-related outcomes in adolescents, an effect that was maintained throughout the vaccination course., This analysis of secondary outcomes of a cluster randomized trial examines the effect of a human papillomavirus (HPV) vaccination education and logistical intervention on adolescent psychosocial outcomes., Importance Delivery of vaccination to adolescents via a school-based program provides an opportunity to promote their involvement in health decision-making, service provision, and self-efficacy (belief in one’s ability to perform a certain behavior). Objective To examine the effect of a human papillomavirus (HPV) vaccination education and logistical intervention on adolescent psychosocial outcomes. Design, Setting, and Participants In this cluster randomized trial and process and qualitative evaluation, adolescents aged 12 to 13 years (first year of high school) were recruited at high schools in Western Australia (WA) and South Australia (SA) in 2013 and 2014. Statistical analysis was performed from January 2016 to December 2020. Interventions The complex intervention consisted of an adolescent intervention to promote knowledge and psychosocial outcomes, shared decisional support tool, and logistical strategies. Main Outcomes and Measures Prespecified secondary outcomes were assessed. The HPV Adolescent Vaccination Intervention Questionnaire (HAVIQ) was used to measure changes in adolescent knowledge (6-item subscale), fear and anxiety (6-item subscale), self-efficacy (5-item subscale), and decision-making (8-item subscale). The hypothesis was that the intervention would improve adolescent involvement in vaccine decision-making (measured before dose 1 only), improve vaccine-related self-efficacy, and reduce vaccine-related fear and anxiety (measured before doses 1, 2, and 3). Mean (SD) scores for each subscale were compared between intervention and control students. In the process evaluation, focus groups were conducted. Analyses of the HAVIQ data were conducted from 2016 to 2020. Qualitative analyses of the focus groups were undertaken from 2017 to 2020. Results The trial included 40 schools (21 intervention and 19 control) across sectors with 6967 adolescents (mean [SD] age, 13.70 [0.45] years). There were 3805 students (1689 girls and 2116 boys) in the intervention group and 3162 students (1471 girls and 1691 boys) in the control group. The overall response rate for the HAVIQ was 55%. In WA, where parental consent was required, the response rate was 35% (1676 of 4751 students); in SA, where parental consent was not required, it was 97% (2166 of 2216 students). The mean (SD) score for decision-making in the intervention group before dose 1 was 3.50 (0.42) of 5 points and 3.40 (0.40) in the control group, a small but significant difference of 0.11 point (95% CI, 0.06 to 0.16 point; P < .001). There was a small difference in favor of the intervention group in reduced vaccination-related anxiety (pre–dose 1 difference, −0.11 point [95% CI, −0.19 to −0.02 point]; pre–dose 2 difference, −0.18 point [95% CI, −0.26 to −0.10 point]; pre–dose 3 difference, −0.18 [95% CI, −0.24 to −0.11]) and increased vaccination self-efficacy (pre–dose 1 difference, 4.0 points; [95% CI, 1.0 to 7.0 points]; pre–dose 2 difference, 4.0 points [95% CI, 2.0 to 6.0 points]; pre–dose 3 difference, 3.0 points [95% CI, 1.0 to 5.0 points]). Focus group data from 111 adolescents in 6 intervention and 5 control schools revealed more confidence and less anxiety with each vaccine dose. Conclusions and Relevance In this cluster randomized trial, there was a small difference in adolescent decisional involvement and vaccine-related confidence and reduced vaccination-related fear and anxiety that was maintained throughout the vaccine course in the intervention vs control groups. Guidelines for vaccination at school should incorporate advice regarding how this outcome can be achieved. Trial Registration Australian and New Zealand Clinical Trials Registry: ACTRN12614000404628

Background: Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. Methods: HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being &gt, 5% absolute lower than dTpa coverage. Results: Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75–90%) and the median dTpa coverage was 86% (IQR:75–92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation &gt, 5% lower than dTpa coverage and 11 % had &gt, 10% difference. School-level factors independently associated with &gt, 5% difference were remote schools (aOR:3.5, 95% CI = 1.7–7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0–3.0), small schools (aOR:3.3, 95% CI = 2.3–5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1–2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2–3.0). Conclusion: The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake.

Background: Little is known about acceptability of the human papillomavirus (HPV) vaccine among parents of adolescents from culturally and linguistically diverse backgrounds in Australia. This study aimed to explore the knowledge and attitudes of parents from Arabic backgrounds towards HPV vaccination offered to their children in the national school-based vaccination program. Methods: Qualitative interviews were conducted in Western Sydney, with parents of adolescents from Arabic backgrounds. Recruitment was via informal personal contacts and passive snowballing. Face-to-face semi-structured interviews were conducted in Arabic. These were audio-recorded, transcribed, and translated into English. Thematic analysis was used to identify emerging themes. Results: Commonly identified themes across fifteen interviews included: (1) lack of awareness and knowledge of HPV and its vaccination, (2) awareness and understanding of the government vaccination information sheet, (3) parents’ preferences for information provision, (4) the role of parents’ religious beliefs in forming attitudes about HPV vaccination, and (5) lost opportunities to educate parents about HPV vaccination during general practitioner (GP) visits. Conclusion: The findings point to the need to address cultural, language, and communication barriers to improve awareness and acceptability of HPV vaccination in the Arabic community. Educational strategies should be tailored to this community based on their specific information needs and preferences.

ObjectiveFertility counselling for trans and gender diverse (TGD) adolescents has many complexities, but there is currently little guidance for clinicians working in this area. This study aimed to identify effective strategies for—and qualities of—fertility counselling for TGD adolescents based on clinicians’ experiences.DesignWe conducted qualitative semi-structured individual interviews in 2019 which explored clinician experiences and fertility counselling practices, perspectives of the young person’s experience and barriers and facilitators to fertility preservation access. Data were analysed using thematic analysis.SettingThis qualitative study examined experiences of clinicians at the Royal Children’s Hospital—a tertiary, hospital-based, referral centre and the main provider of paediatric TGD healthcare in Victoria, Australia.ParticipantsWe interviewed 12 clinicians from a range of disciplines (paediatrics, psychology, psychiatry and gynaecology), all of whom were involved with fertility counselling for TGD adolescents.ResultsBased on clinician experiences, we identified five elements that can contribute to an effective approach for fertility counselling for TGD adolescents: a multidisciplinary team approach; shared decision-making between adolescents, their parents and clinicians; specific efforts to facilitate patient engagement; flexible personalised care; and reflective practice.ConclusionsIdentification of these different elements can inform and hopefully improve future fertility counselling practices for TGD adolescents, but further studies examining TGD adolescents’ experiences of fertility counselling are also required.

Introduction This qualitative study aimed to explore parental attitudes, knowledge and decision-making about HPV vaccination for adolescents in the context of a gender-neutral school-based Australian National Immunisation Program (NIP). Methods Semi-structured interviews with parents of adolescents eligible for HPV vaccination were undertaken as part of an evaluation of a cluster-randomised controlled trial of a complex intervention in 40 schools (2013–2015). In this qualitative study, we purposively recruited a nested sample of parents from 11 schools across two Australian jurisdictions. Interviews explored parent knowledge and understanding of the HPV vaccine program; HPV vaccination decision-making; their adolescent’s knowledge about HPV vaccination; and their adolescent’s understanding about HPV vaccination, sexual awareness and behaviour. Transcripts were analysed using inductive and deductive thematic analysis. Results Parents’ of 22 adolescents had positive attitudes towards the program; the school-based delivery platform was the key driver shaping acceptance of and decision-making about HPV vaccination. They had difficulty recalling, or did not read, HPV vaccination information sent home. Some adolescents were involved in discussions about vaccination, with parents’ responsible for ultimate vaccine decision-making. All parents supported in-school education for adolescents about HPV and HPV vaccination. Parents’ knowledge about HPV vaccination was limited to cervical cancer and was largely absent regarding vaccination in males. Conclusions Parents’ positive attitudes towards the NIP and inclusion of the HPV vaccine is central to their vaccine decision-making and acceptance. More intensive communication strategies including school education opportunities are required to improve parents’ knowledge of HPV-related disease and to promote vaccine decision-making with adolescents.

Most vaccinations are performed by intramuscular injection with a needle and syringe. However, this method is not ideal due to limitations, such as the risk of needle-stick injury, the requirement for trained personnel to give injections and the need to reconstitute lyophilized vaccines. Therefore, we tested an alternative delivery technology that overcomes the problems with needle and syringe. The Nanopatch (TM) is an array of 10,000 silicon micro-projections per cm(2) that can be dry-coated with vaccine for skin delivery. The high number and density of micro-projections means that high velocity application is required to achieve consistent skin penetration. Before clinically testing a vaccine Nanopatch, this study tests the safety, tolerability and acceptability/utility of uncoated and excipient-coated Nanopatches in healthy adults.

The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for girls and in 2013 for boys, using the quadrivalent HPV [4vHPV] vaccine. In Australia, students are primarily vaccinated en masse, on school grounds, after parental/guardian consent is obtained. Students most often receive little, or no, education at school about HPV or HPV vaccination prior to immunisation. There is also some uncertainty about where young people can and should obtain reliable information about the vaccine, outside of school. We conducted a cluster randomised controlled trial of a complex intervention in schools. This study aimed to improve: (1) student knowledge about HPV vaccination; (2) psycho-social outcomes and (3) vaccination uptake. In this paper, we briefly outline our educational intervention and discuss its implementation by educators including facilitators and barriers. We also discuss the study findings pertaining to student knowledge about HPV and HPV vaccination and their at...

Sexual health emerges as a key aspect of wellbeing during adolescence. Adolescents’ lives are marked by intense developmental changes, not limited to peak physical growth and cognitive maturation, but major transitions in psychological, social and relationship goals and strivings. For girls, the challenge to achieve sexual health and wellbeing often in spite of external cultural and societal barriers is one that must be supported by evidence-based policy and health resourcing. Here we present the case, using a health and human rights lens, for why adolescent girls’ sexual and reproductive health is a key indicator of women’s health globally. We present the current data on adolescent sexual behaviour, sexuality and gender diversity and health across countries. Vulnerabilities of gender and sexuality diverse young people are explored as are adolescent girls’ challenges in accessing sexual and health services. We discuss why inclusive comprehensive sexuality education is essential to supporting adolescent girls in achieving sexual health and why it should be universal. Effective interventions in schools and the community setting, which have been demonstrated to promote safe sexual behaviour, reduce sexually transmitted infections and unplanned adolescent pregnancies, are summarised.

Objective: Australia has implemented a nation-wide programme providing a human papillomavirus (HPV) vaccine to girls and boys through school-based programmes. Previous research has identified three distinct areas for attention: (1) lack of understanding about HPV and HPV vaccination, (2) young people’s desire for involvement in decision-making about HPV vaccination and (3) fear of HPV vaccination. We aimed to develop an intervention to address young people’s low levels of understanding, to promote their involvement in consent and reduce vaccination-related fear and anxiety. Design, Setting, Methods: Formative qualitative research was conducted in six public, private and Catholic schools in the Sydney metropolitan area. Girls who were offered the vaccine in a school programme and aged 12–13 years were interviewed in focus groups. Piloting of materials was conducted in three private schools across Sydney with both girls and boys, and changes and additions were made to the materials in accordance with feedback. Results: We developed an educational intervention aimed at addressing gaps in young people’s knowledge and understanding, and offering strategies to improve confidence with vaccination and reduce needle-related anxiety. Components of the final intervention include film chapters, a magazine, a website, an app and teacher support materials. The intervention is designed for teachers and/or nurses to deliver and is linked to the school-based HPV vaccination programme. Conclusions: This is the first educational intervention designed for young people in HPV school-based vaccination, to be developed from empirical data with the involvement of young people themselves.

This chapter analyses results from an intervention in Australian schools designed to educate young people about human papillomavirus (HPV) and HPV vaccination, and improve vaccination experiences. Despite media campaigns, adolescents’ understanding, self-efficacy, and involvement in decision-making regarding HPV vaccination are low, and their fear and anxiety are high. This chapter outlines the design, implementation, and evaluation of tools from our health intervention that addressed this desire for knowledge and fear of needles: an HPV vaccination app and website with education and distraction components, and a biofeedback-controlled interactive art app that combines relaxation training with multimedia distraction, called ‘BrightHearts’.

Background: Injection using needle and syringe (Namp;S) is the most widely used method for vaccination, but requires trained healthcare workers. Fear of needles, risk of needle-stick injury, and the need to reconstitute lyophilised vaccines, are also drawbacks. The Nanopatch (NP) is a microarray skin patch comprised of a high-density array of microprojections dry-coated with vaccine that is being developed to address these shortcomings. Here we report a randomised, partly-blinded, placebo-controlled trial that represents the first use in humans of the NP to deliver a vaccine. Methods: Healthy volunteers were vaccinated once with one of the following: (1) NPs coated with split inactivated influenza virus (A/California/07/2009 [H1N1], 15 mu g haemagglutinin (HA) per dose), applied to the volar forearm (NP-HAIFA), n = 15; (2) NPs coated with split inactivated influenza virus (A/California/07/2009 11-11N1 I, 15 mu g HA per dose), applied to the upper arm (NP-HA/UA), n = 15; (3) Fluvaxe (R) 2016 containing 15 mu g of the same H1N1 HA antigen injected intramuscularly (IM) into the deltoid (IM-HA/D), n = 15; (4) NPs coated with excipients only, applied to the volar forearm (NP-placebo/FA), n = 5; (5) NPs coated with excipients only applied to the upper arm (NP-placebo/UA), n = 5; or (6) Saline injected IM into the deltoid (IM-placebo/D), n = 5. Antibody responses at days 0, 7, and 21 were measured by haemagglutination inhibition (HAI) and microneutralisation (MN) assays. Findings: NP vaccination was safe and acceptable; all adverse events were mild or moderate. Most subjects (55%) receiving patch vaccinations (HA or placebo) preferred the NP compared with their past experience of IM injection with Namp;S (preferred by 24%). The antigen-vaccinated groups had statistically higher HAI titres at day 7 and 21 compared with baseline (p amp;lt; 0.0001), with no statistical differences between the treatment groups (p amp;gt; 0.05), although the group sizes were small. The geometric mean HAI titres at day 21 for the NP-HA/FA, NP-HA/UA and IM-HA/D groups were: 335 (189-593 95% CI), 160 (74-345 95% CI), and 221 (129-380 95% CI) respectively. A similar pattern of responses was seen with the MN assays. Application site reactions were mild or moderate, and more marked with the influenza vaccine NPs than with the placebo or IM injection. Interpretation: Influenza vaccination using the NP appeared to be safe, and acceptable in this first time in humans study, and induced similar immune responses to vaccination by IM injection. (C) 2018 The Author(s). Published by Elsevier Ltd. Funding Agencies|Vaxxas Pty Ltd, Brisbane, QLD, Australia [ACTRN12616000880448]

Purpose Young adult males (YAMs) are understudied with respect to lifestyle interventions to address overweight and obesity in this group. This study reports on the participatory design of the structure and delivery of the Fit4YAMs text message–based lifestyle intervention for 18- to 25-year-old rural YAMs in Australia. Methods Two semi-structured focus group discussions were held with six overweight or obese YAMs. Sessions explored their preferences for the structure and delivery of a weight loss intervention. Focus groups were recorded, and the contents transcribed verbatim for thematic analysis. Results The YAMs were unanimous in their preference for a highly personalized intervention program, complete with personalized goal setting, personalized motivation and engagement strategies, and personalized text message content. A text message frequency of three–four messages per week was deemed optimal for this group. Minimal direct contact by the intervention team was requested, but with clear guidelines and reminders of key contacts whom they could contact should they require help and guidance. The YAMs also agreed that a comprehensive goal setting session and personalization session prior to commencement of the intervention would be best. Conclusions To engage rural YAMs in lifestyle interventions, a high degree of personalization of the program appears important. Although initially more time and resource intensive than a less personalized approach, it is essential to identify strategies to prevent and reverse weight gain in this hard to engage group. Maximizing their engagement using a more personalized approach could be the key to promoting long-term health outcomes in this group.

Based on empirical research, this chapter explores the complex regulatory relationship between childhood and sexuality in many Western cultures. We focus on two main areas: (i) an examination of discourses underpinning the repression and regulation of children’s access to knowledge of sexuality; and (ii) an exploration of children’s sexual subjectivities. Controversy around sexuality education with children has resulted in strict regulatory practices imposed and self-imposed on both teachers and parents. We argue that regulating children’s access to knowledge and knowledge production—associated with sexuality in particular—operates to inscribe children as ‘vulnerable’ subjects. There is a need for building strong ethical and respectful relationships and sexuality literacy early in life, which are foundational to understandings of children’s sexual citizenship, and to their health and well-being.

Children’s gendered and sexual cultures are dynamic and involve complex negotiations between various stakeholders, including children, families, educators, the media and the broader community. This chapter, based on qualitative research undertaken with children, parents/guardians and educators in Australia, examines how the discourse of marriage features predominantly in children’s gendered and sexual cultures, significantly influencing their understandings of love, intimacy and relationships.1 Employing a theoretical lens that encompasses feminist post-structuralism, queer theory and post-developmentalism, we explore how children constitute their own gendered and sexual subjectivities. Fundamental to this process is heteronormativity, which regulates many children’s perceptions of the ‘appropriate’ girl and boy subject, ideals of romantic love and marriage. The ritual of marriage, which in Western cultures is linked to discourses of romantic love, family and having children, is central to children’s enculturation within heteronormative values and morals. Children take up the discourse of marriage, mimetically incorporating its symbolic meaning into their imaginary worlds. The hegemony of the romantic, fairytale and carnivalesque nature of Western marriages further captures children’s desire to be part of this sociocultural ritual.

Introduction In the context of universal (male and female) school based HPV vaccination program, we evaluated a complex intervention to promote: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake. Methods We recruited a stratified random sample of schools across two Australian states, and randomly allocated to intervention or control. The intervention included adolescent education; distraction/relaxation on vaccination day; a brochure and decisional support tool for adolescents and parents; and program logistical strategies, in addition to routine state based vaccination guidelines. Both intervention and control followed routine state based guidelines. We compared intervention and control with regard to: student questionnaire data pre-dose 1, 2, 3 on HPV knowledge, vaccination decisional involvement, vaccination self-efficacy, fear and anxiety, and vaccine uptake. Immunisation data collection was ongoing in 2015. Results We recruited 21 intervention schools (3806 students) and 19 control (3159). Pre-dose 1 questionnaire student knowledge: 65% vs. 33% correct responses, (difference 32%; 95% CI: 27%, 36%); decisional involvement score: 3.7 vs. 3.6 (difference 0.11; 95% CI: 0.06, 0.16); self-efficacy score: 74 vs. 71 (difference 4; 95% CI 1, 7); fear/anxiety score: 2.6 vs. 2.7 (difference -0.11; 95% CI: -0.19, -0.02). At least one vaccine dose was given to 3277 (86.1%) students in intervention schools versus 2697 (85.4%) in control schools, difference 0.4% (95% CI: -2.6, 3.3). Conclusion Our intervention significantly improved adolescent knowledge and psycho-social outcomes, but not HPV vaccination coverage, which was high in both groups, resulting in a possible ceiling effect. Disclosure of interest statement This study was funded through a National Health and Medical Research Council Project Grant (1026765) and an investigator driven bioCSL research grant. SR. Skinner’s institution has received honoraria for Advisory Board meetings and educational symposia from GSKbiologicals and Pfizer.