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

Team Outcomes

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).

Cervical Cancer Screening in Peru: A Global Value Chain Analysis of the Pocket Colposcope

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 the Pocket Colposcope Addresses Issues Related to Cervical Cancer Care in LMICs (Mercy Asiedu)

How mHealth Assists Pocket Colposcope Utilization (Shengjie Xu)

Mobile Health and the Pocket Colposcope (Avni Mehta)

Adapting Treatment Strategies for Low-Resource Settings (Shruti Rao)

Ethical Implications (Mercy Asiedu)

Pocket: Reducing Cervical Cancer in Peru through GVC Analysis

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)

Shruti Rao

Manish Nair

This Team in the News

Duke Researchers Discover Way to Make Cervical Cancer Screening More Accessible, Affordable

New Tech Promises Easier Cervical Cancer Screening

Manish Nair: Closer to a Tool to Fight Cervical Cancer

From Duke’s Labs to Patients in Peru: Students Work to Deploy New Cervical Cancer Screening Tool

Duke Team Reaches Milestone with Portable Cervical Cancer Screening Device

Researchers Aim to Make Cervical Cancer Screening Accessible to All

Showing Washington the Future of Global Women’s Health

Bass Connections Team Members Share Their Global Health Research and Win Awards

And the Best Global Health Photos and Posters Are…

Meet the Members of the Bass Connections Student Advisory Council

Students Explore Human Side of Engineering in Peru

See related team, Pocket Colposcope: Increased Distribution and Adoption (2017-2018).

Team Leaders

  • 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-Family Medicine and Community Health