Pocket Colposcope: Increased Distribution and Adoption (2016-2017)
Cervical cancer affects 500,000 women worldwide each year, resulting in more than 270,000 deaths annually. The majority of cases occur in low-income countries that cannot afford the tools commonly used in the United States. To address this challenge, researchers at Duke’s Global Women’s Health Technologies Center developed the Pocket (Point of Care Tampon) Colposcope to screen for cervical cancer. It has similar clinical performance to the existing standard of care colposcope, but has lower capital and maintenance costs ($250 compared to $20,000) and increased portability. They are seeking approvals to introduce the Pocket Colposcope into Peru and East Africa where they currently have regulatory approval but require market approval.
This Bass Connections project team used an innovative approach to identify the best strategy for adoption of the Pocket Colposcope in a country-specific setting. The global value chain analysis framework uses a holistic, system-based approach to map the ecosystem of activities and actors involved in a given development project.
Team members began by learning about the history, biology and prevalence of cervical cancer and various tools for diagnosing and treatment, and spent several weeks learning about the Pocket Colposcope device. They worked in teams to produce weekly reflection posts on the issues discussed, and used these as the basis of the front end of their final report. Manish Nair finalized his data analysis for a pilot study done in Summer 2016 and presented his findings at the Duke Global Health Institute’s Global Health Showcase.
To map the global value chain of the Pocket Colposcope, team members identified key stakeholders for interviews, drafted an interview guide and conducted field research in Peru in March 2017. These interviews were used to identify six leverage points where specific actions can help increase the likelihood of adoption of the Pocket Colposcope.
One leverage point is midwife training. Currently in Peru, colposcopy can only be performed by trained gynecologists. To increase access to cervical cancer screening, midwives can be trained to perform colposcopy with the Pocket Colposcope. Trainings should cover image capture, patient identification, telecommunication and disinfection. Another leverage point is telecommunication. Widely used in high-income countries, telemedicine leverages information and communication technologies to overcome geographical barriers and improve health. Because there are few trained medical professionals working in the Amazon forest, jungles, highlands and mountains of Peru, these areas are prime targets for telemedicine interventions.
Team members wrote a report, shared it with implementing partners, refined their recommendations and produced a final report that identifies the relevant actors, policies and leverage points for technology adoption.
Summer 2016 – Spring 2017
Mercy Nyamewaa Asiedu, Júlia Agudogo, Marlee S. Krieger, Robert Miros, Rae Jean Proeschold-Bell, John W. Schmitt, Nimmi Ramanujam. 2017. “Design and preliminary analysis of a vaginal inserter for speculum-free cervical cancer screening.” PLoS ONE 12(5).
Global Value Chain Analysis of the Pocket Colposcope (Manish Nair; winner of Duke Global Health Institute Poster Award, first place)
A Brief History of Cervical Cancer (Hiba Farah, Shengjie Xu, Shruti Rao, Ross Winston)
Cervical Cancer: Global Prevalence and Mortality (Mercy Asiedu)
HPV Vaccination in Women (Hiba Farah)
HPV Vaccination in Men (Mercy Asiedu)
Challenges of Technology Implementation (Shengjie Xu)
Key Components of Cervical Cancer Screening (Mercy Asiedu, Rachel Glenn, Emily Mason, Avni Mehta, Manish Nair)
Pocket Colposcope and LMICs (Mercy Asiedu)
How mHealth Assists Pocket Colposcope Utilization (Shengjie Xu)
Mobile Health and the Pocket Colposcope (Avni Mehta)
Ethical Implications (Mercy Asiedu)
Nimmi Ramanujam. A Novel Optica Spectral Imaging System for Rapid Imaging of Breast Tumor Margins ($2,741,596 grant awarded from the National Institute of Health, 2011)
YOLO: You Only Lima Once (Shruti Rao)
Until Next Time, Peru (Manish Nair)
Mobile Clinics in Lima (Manish Nair)
Doktuz: Bringing Healthcare to Homes (Manish Nair)
Revolutionizing Healthcare with Technology (Manish Nair)
The Potential of the Pocket Colposcope (Manish Nair)
Global Value Chain Analysis of the Pocket Colposcope (Manish Nair)
Screeching Sounds and Impassioned Hearts (Manish Nair)
This Team in the News
See related team, Pocket Colposcope: Increased Distribution and Adoption (2017-2018).
- Rae Jean Proeschold-Bell, Duke Global Health Institute
- Nimmi Ramanujam, Pratt School of Engineering-Biomedical Engineering
/graduate Team Members
Mercy Asiedu, Biomedical Engineering-PHD
Emily Mason, Business Administration-MBA, Health Sector Management
Shengjie Xu, Immunology-PHD
/undergraduate Team Members
Hiba Farah, Psychology (AB)
Rachel Glenn, Program II (BS)
Avni Mehta, Biomedical Engineering (BSE)
Manish Nair, Biomedical Engineering (BSE), Global Health (AB2)
Shruti Rao, Program II (AB)
James (Ross) Winston, Sociology (AB)
/yfaculty/staff Team Members
Danny Hamrick, Social Science Research Institute-Global Value Chains Center
Marlee Krieger, Pratt School of Engineering-Biomedical Engineering
Lavanya Vasudevan, School of Medicine-Community and Family Medicine