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 costing, policy and acceptability tools developed by previous teams to assess the feasibility of introducing the Pocket Colposcope as triage for HPV positive women in two different regions in Peru.

Project Description

This project team will partner with Project HOPE to assess barriers to the acceptance and implementation of the Pocket Colposcope from both the patient and provider perspectives Cajamarca and Ventanilla, Peru.

Project HOPE, founded by former health minister of Peru (Dr. Patricia Garcia), implements self-HPV screening in several low-income regions in Peru HOPE and has established: 1) the use of molecular tests to detect HPV through self-testing, 2) the engagement of women in the community (HOPE Ladies) to educate women on cervical cancer testing and distribute HPV self-testing kits and 3) the use of cell phones to send results, appointments and reminders to women, and track care on an informatics platform.

Team members will evaluate cost inputs necessary for the implementation of the Pocket Colposcope with self-HPV testing in a community health setting. The team will use this information to determine how the Pocket Colposcope can be positioned for widespread scale-up in a decentralized care model.

Team members will also convene interviews and panels with stakeholders at Cayetano Heredia University. This will include a trip to both regions in where students will have the opportunity to coordinate meetings with local representatives, healthcare providers and community health workers who lead the self-HPV screening programs.

The qualitative data gained from these interviews will be used to inform the creation of briefs regarding the current screening model and the potential to incorporate the Pocket Colposcope as a triage for HPV+ women.

Specific project goals include:

  1. Understanding the history of the Pocket Colposcope and the work performed to date, both within and outside the long-running Bass Connections project team.
  2. Utilizing existing surveys and training materials to conduct a stakeholder analysis of the acceptability of the Pocket Colposcope in the two low-income regions in Peru to inform a roadmap for implementation of the device in at least 12 clinics in Cajamarca and Ventanilla.
  3. Issuing a series of briefs based on recommendations from public health experts regarding the conventional cervical cancer screening/care paradigm.
  4. Completing a cost-effectiveness analysis of self-HPV and Pocket Colposcopy based on current and proposed health care delivery models.

Anticipated Outputs

Stakeholder assessments; policy briefs; 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 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 Peru
  • Spring 2020: Field visits and interviews in Peru; semi-structured interviews with stakeholders using interview guides; qualitative data translation; comprehensive review of policy literature; drafting of policy briefs

Team Outputs to Date

Community Care and Triage (Fortin Foundation Bass Connections Virtual Showcase 2020)

Pocket Colposcope: Assessing the Acceptability, Cost-effectiveness and Policy Landscape of a Community-driven, See-and-treat Model for Tackling Cervical Cancer (poster by Karina Moreno Bueno, Caroline Doherty, Abigail Farley, Angel Heredia, Morgan McKinney, Rachel Mundaden, Lillian Zhu)


Bass Connections Peru Spring Break Trip 2020—Rachel Mudaden

This Team in the News

New Hope for Fixing Health System Failures to Prevent and Treat Cervical Cancer

Hello from #Peru2020!

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
  • Nimmi Ramanujam, Pratt School of Engineering-Biomedical Engineering

/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

  • Mary Ann Dotson, Center for Global Women’s Health Technologies and Biomedical Engineering
  • Megan Huchko, School of Medicine-Obstetrics and Gynecology
  • Carolyn Rapp, Global Women's Health Technologies
  • Andrea Thoumi, Margolis Center for Health Policy

/zcommunity Team Members

  • Patricia Garcia, Cayetano Heredia - School of Public Health