Pocket Colposcope: Analysis of Bringing Elements of Referral Services to Community Care (2019-2020)


Invasive cervical cancer affects 500,000 women worldwide each year. Unlike most cancers, however, it is highly preventable.

The current cervical cancer care paradigm is a three touch-point model, including 1) screening in a community care setting, 2) confirmatory diagnosis by colposcopy and biopsy in a referral setting and 3) treatment for screen-positive women in a facility equipped for such care. However, it is well documented that that between 20 to 90 percent of women (depending on clinical location) can be lost at each stage of the follow-up process, especially in medically underserved regions.

Since 2012, Duke researchers have been working to develop a low-cost, portable cervical cancer screening device called the Pocket Colposcope, which has the potential to expand access to cervical cancer screening and diagnosis worldwide. Since 2016, this Bass Connections team has been working to introduce this device in low- and middle-income country settings.

In 2016-17, the team performed a global value chain analysis in order to identify leverage points to increase the likelihood of the device’s adoption in Peru. In 2017-18, team members focused on launching a community health provider program (including creating training programs and toolkits) to implement the Pocket Colposcope at the primary care setting in Peru. And, in 2018-2019, the team conducted an analysis of the clinical acceptability, policy implications and cost-effectiveness of bringing the device to community health providers in the region.

In 2019-2020, the team will leverage the framework constructed for analysis in Peru and adapt it to the community health setting in low-income regions of North Carolina with the aim of demonstrating that the Pocket Colposcope can successfully transition colposcopy from referral care to a primary-care setting.

Project Description

This Bass Connections project team will partner with three Duke-affiliated community clinics in low-income settings in North Carolina to assess barriers to acceptance and implementation of the Pocket Colposcope from both the patient and provider perspectives. Team members will evaluate cost inputs necessary for implementing the device in a community health setting and use this information to determine how the Pocket Colposcope can be positioned for widespread scaling in a decentralized care model.

The team will also engage with policy stakeholders at Duke as well as at the state and federal levels. This will include a trip to Washington, D.C., in Spring 2020 where team members will have the opportunity to coordinate meetings with policy makers and representatives from agencies such as the Centers for Medicare and Medicaid Services, the American Congress of Obstetricians and Gynecologists and the American Telemedicine Association, among others. Team members will use the qualitative data gained from these discussions to create policy briefs regarding the current care model. These briefs will present policy options for North Carolina state policy makers, the federal government and additional stakeholders.

Anticipated Outputs

Stakeholder assessments; policy briefs; adapted training models for the Pocket Colposcope in Peruvian and North Carolina health provider contexts; cost-efficacy analyses


Summer 2019 – Spring 2020

  • Fall 2019: Responsible conduct of research, human subjects research and laboratory safety trainings (completed remotely before arrival on campus); overview of cervical cancer prevention and health care systems in domestic and global contexts; recap of the global value chain model and economic viability analysis generated by previous teams; overview of Pocket Colposcope and current framework of health policy creation and reform in the U.S.
  • Spring 2020: Field visits and interviews in Duke-affiliated community clinics; semi-structured interviews with stakeholders using interview guides; qualitative data translation; comprehensive review of policy literature; drafting of policy briefs

This Team in the News

John Schmitt, MD, Receives Bass Connections Award

See earlier related team, Pocket Colposcope: Analysis of Bringing Elements of Referral Services to Primary/Community Care (2018-2019).


Image: Duke engineering professor Nimmi Ramanujam and postdoc Jenna Mueller with Pocket Colposcope prototype (by Jared Lazarus)

Duke engineering professor Nimmi Ramanujam and postdoc Jenna Mueller with Pocket Colposcope prototype (by Jared Lazarus)

Team Leaders

  • Marlee Krieger, Pratt School of Engineering-Biomedical Engineering
  • John Schmitt, School of Medicine-Obstetrics and Gynecology

/graduate Team Members

  • Jugal Karda, Master of Engineering Mgmt-MEG
  • Praveena Motupalli, Master of Quantitative Mgmt

/undergraduate Team Members

  • Caroline Doherty
  • Abigail Farley
  • Angel Heredia, Political Science (AB)
  • Morgan McKinney, Public Policy Studies (AB), Global Health (AB2)
  • Karina Moreno Bueno, Biology (BS), Global Health (AB2)
  • Rachel Mundaden
  • Lillian Zhu, Biology (BS)

/yfaculty/staff Team Members

  • Megan Huchko, School of Medicine-Obstetrics and Gynecology
  • Mark McClellan, Margolis Center for Health Policy
  • Nimmi Ramanujam, Pratt School of Engineering-Biomedical Engineering
  • Elena Roberts, Pratt School of Engineering-Biomedical Engineering
  • Christina Silcox, Margolis Center for Health Policy
  • Lavanya Vasudevan, School of Medicine-Community and Family Medicine
  • Michael Waitzkin, Science & Society

/zcommunity Team Members

  • Linda Muasher, Lincoln Community Health Center
  • Matthew Zerden, Planned Parenthood