Abstract
In many developing nations, cervical cancer screening is done by visual inspection with acetic acid (VIA). Monitoring and evaluation (M&E) of such screening programs is challenging. An enhanced visual assessment (EVA) system was developed to augment VIA procedures in low-resource settings. The EVA System consists of a mobile colposcope built around a smartphone, and an online image portal for storing and annotating images. A smartphone app is used to control the mobile colposcope, and upload pictures to the image portal. In this paper, a new app feature that documents clinical decisions using an integrated job aid was deployed in a cervical cancer screening camp in Kenya. Six organizations conducting VIA used the EVA System to screen 824 patients over the course of a week, and providers recorded their diagnoses and treatments in the application. Real-time aggregated statistics were broadcast on a public website. Screening organizations were able to assess the number of patients screened, alongside treatment rates, and the patients who tested positive and required treatment in real time, which allowed them to make adjustments as needed. The real-time M&E enabled by “smart” diagnostic medical devices holds promise for broader use in screening programs in low-resource settings.
Highlights
Cervical cancer is the leading cause of cancer death for women in low-resource settings, with528,000 new cases each year that result in 266,000 deaths [1]
In 70 low- and middle-income countries (LMICs) around the world, cervical cancer screening is done by visual inspection with acetic acid (VIA), an easy to implement procedure with limited diagnostic accuracy in which a practitioner applies a thin layer of 3%–5% acetic acid to the cervix and visualizes it from outside the vaginal canal using a light source [4]
Previous studies have shown that VIA is a cost-effective screening method for cervical cancer in LMICs [5], but its contribution to improving health outcomes is difficult to Diagnostics 2016, 6, 20; doi:10.3390/diagnostics6020020
Summary
Cervical cancer is the leading cause of cancer death for women in low-resource settings, with528,000 new cases each year that result in 266,000 deaths [1]. Pap testing requires a clinical workforce and laboratory infrastructure that is lacking in many LMICs, and as a result, patients do not have access to this level of regular screening. It is widely believed that increasing access to regular cervical cancer screening in LMICs would reduce mortality from the disease [1,3]. Previous studies have shown that VIA is a cost-effective screening method for cervical cancer in LMICs [5], but its contribution to improving health outcomes is difficult to Diagnostics 2016, 6, 20; doi:10.3390/diagnostics6020020 www.mdpi.com/journal/diagnostics estimate [6]. The low cost ($6 per test) and relative ease of implementation of VIA programs make it an appealing option for manywith public health programs, coupled with onsite treatment treatment of suspicious lesions cryotherapy ($28 perparticularly application)when [7]. VIA suffers from of suspicious lesions with cryotherapy ($28meaning per application)
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