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 have 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.

Project Description

This project team will use an innovative approach to identify the best strategy for adoption of the Pocket Colposcope in a country-specific setting. The value chain analysis framework uses a holistic, system-based approach to map the ecosystem of activities and actors involved in a given development project. The team will map the stakeholders involved in the implementation of the Pocket Colposcope in Peru and conduct the value chain analysis in collaboration with La Liga Contra el Cancer in Lima. Their efforts will enumerate crucial leverage points where specific actions can help increase the likelihood of adoption of the Pocket Colposcope in Peru.

In the first half of the project, team members became familiar with 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. Weekly team meetings were designed around specific topics and questions led by experts from Duke and beyond. Students 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. One team member finalized his data analysis for a pilot study done over the summer, and presented his findings at the Duke Global Health Institute’s Global Health Showcase on November 3, 2016.

Team members are currently mapping the global value chain of the Pocket Colposcope. They will identify key stakeholders for interviews, draft an interview guide and conduct field research in Peru in March 2017. Interviews will be used to identify a set of crucial leverage points that influence distribution and adoption success and potential strategies to increase success regarding these leverage points.

Anticipated Outcomes

The team expects to identify actions that will maximize adoption of the Pocket Colposcope in Peru. This will be accomplished through stakeholder analysis and examination of the policy environment in Peru, as well as through comparative case studies of other technology introductions there. Although this work will yield information specific to Peru, cervical cancer is a social issue relevant across the globe. Therefore, the team anticipates that several lessons will generalize to help guide future launches in other countries, particularly those in East Africa.

Team members will submit midyear written report of the progress to date and a research plan. They will write a formal report, share it with implementing partners, lead a discussion on the report with partners, refine their recommendations and produce a final report.

Related Courses

BME 290, The Intersection of Technologies and Women’s Health (Spring); BME 551, Optical Spectroscopy Tissue Optics (Fall)


August 2016 – June 2017

Weekly meetings will cover global cervical cancer and health disparities; cervical cancer screening technologies and health care systems; and value chain analysis. These meetings will lead to a site visit to Peru over spring break/summer in 2017. Modules will introduce the project and relevant themes around global health, technology and medicine, as well as training with the value chain methodology, stakeholder analysis, public policy and business. The spring semester will look at the Peru case in-depth as well as provide training on the research skills, including qualitative and quantitative data collection, needed to prepare for the spring trip. Upon return, we will synthesize the data and draft a final report that identifies the relevant actors, policies and leverage points for technology adoption.

Team Outcomes to Date

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

Global Value Chain Analysis of the Pocket Colposcope (poster by 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)


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

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


Faculty/Staff Team Members

Danny Hamrick, Social Science Research Institute, Center on Globalization, Governance and Competitiveness
Marlee Krieger, Pratt School - Biomedical Engineering
Rae Jean Proeschold-Bell, Duke Global Health Institute*
Nimmi Ramanujam, Pratt School - Biomedical Engineering*
Lavanya Vasudevan, Duke Global Health Institute

Graduate Team Members

Mercy Asiedu, Pratt - Biomedical Engineering
Shengjie Xu, PhD in Immunology

Undergraduate Team Members

Hiba Farah, Global Health (AB), Psychology (BS2)
Rachel Glenn, Program II (AB)
Avni Mehta, Biomedical Engineering, Economics (AB2)
Manish Nair, Global Health (AB)
Shruti Rao, Program II (AB)
James (Ross) Winston

* denotes team leader