Pocket Colposcope: Increased Distribution and Adoption (2017-2018)

Background

Cervical cancer affects the lives of 500,000 women worldwide each year, resulting in more than 270,000 deaths annually. Because the majority of cases occur in low-income countries that cannot afford the tools commonly used in the United States, new solutions must be found.

To address this challenge, researchers at Duke’s Global Women’s Health Technologies Center have developed a Pocket (Point-of-Care Tampon) Colposcope to screen for cervical cancer in low-resource settings. The Pocket Colposcope 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.

In an ongoing clinical investigation at La Liga Contra el Cancer in Lima, Peru, team leaders found the sensitivity and specificity of the Pocket Colposcope when compared to the gold standard to be 92.0% and 69.4%, respectively, for identifying low and high grade precancers (62 patients). With our partner 3rd Stone Design, we have developed and fully validated alpha prototypes of the Pocket Colposcope. The alpha device features refined aesthetics and ergonomics, on-board controls for improved usability and options to capture cervical images.

The first version of this Bass Connections project (2016-2017) has been conducting a global value chain analysis where the identification of specific actions can help increase the likelihood of adoption of the Pocket Colposcope in Peru. The outcome will provide a roadmap for the technical, clinical, commercial and regulatory processes that will be necessary to disseminate the technology in this country.

Project Description

The 2017-2018 Bass Connections project will focus on the activities involved in launching a community health provider program to implement Pocket colposcopy at the primary care setting. Community health providers include providers at the first level of healthcare service, including doctors, nurses and technicians.

The specific goals of the project are to:

  1. Understand the best practices for creating a training program for community-level providers
  2. Develop a comprehensive and culturally appropriate training manual that will be iterated on based on feedback from community health providers working with La Liga Contra el Cancer
  3. Do a preliminary field testing of their training protocols over four weeks in Lima, Peru (in addition, a subset of the team members will be invited to spend the entire summer in Lima, using funding from the Center for Global Women’s Health Technologies, to assess the impact of the training model on the Peruvian community health providers and be responsible to work with the team leaders to disseminate this work in the form of a manuscript).

Anticipated Outcomes

Detailed training model for community health providers to interpret colposcopy images; assessment of how well the providers perform relative to expert colposcopists; detailed and culturally appropriate training model for the physical use of the Pocket Colposcope in the community setting

Timing

Summer 2017 – Summer 2018

  • Summer 2017: Pre-project training in July (students will complete the requisite training modules, including the responsible conduct of research, so they may actively participate in clinical and lab research during the duration of the project); required human subjects research training through the Collaborative Institutional Training Initiative (CITI) and general laboratory safety training through Duke’s Environmental and Occupational Safety Office
  • Fall 2017: Module 1: overview of cervical cancer prevention and healthcare systems (public and private) in Peru; recap of the global value chain analysis performed in the first Bass Connections project; Module 2: overview of Pocket Colposcope, best practices for training community health providers in the context of cervical cancer prevention
  • Spring 2018: Module 3: developing training protocols to educate community health providers on the interpretation of cervical images obtained with Pocket Colposcope without the need for a physician; Module 4: developing a model for training community health providers to implement Pocket Colposcope in Peru
  • Summer 2018: Field visits and interviews in Peru

Team Outcomes to Date

Cervical Cancer Care in Peru: Leveraging the Pocket Colposcope to Reduce Loss to Follow Up (poster by Nimmi Ramanujam, Jose Jeronimo, Megan Huchko, Ernesto Ortiz, Marlee Krieger); Audience Choice Winner at Bass Connections Showcase, April 18, 2018

Mueller J*, Asma B*, Lam C, Krieger M, Asiedu M, Gallagher J, Hariprasad R, Malliga J, Mchome B, Oneko O, Taylor P, Venegas G, Wanyoro A, Muasher L, Schmitt J, Ramanujam N. 2017. "Evaluation of a point of care tampon (POCkeT) colposcope as a screening device for cervical cancer among international physicians." Journal of Lower Genital Tract Disease 21(2):112-119. *Authors contributed equally.

Lam C, Mueller J, Asma B, Asiedu M, Krieger M, Chitalia R, Dahl D, Schmitt J, Ramanujam N. "Integrated strategy for improving durability, contrast, and portability of the POCkeT Colposcope for cervical cancer screening." PLoS one, submitted.

Reflections

Ryan Fitzgerald

Emily Mason

Video

Bass Connections 2018 - Working on Site in Lima, Peru

This Team in the News

Concept to Care Delivery of the Pocket Colposcope: A Unique Ph.D. Experience

Bass Connections Showcase Presents Research Highlights from Durham to Malaysia

Mobile Screening Clinics in Peru

Three DGHI Faculty and Students Receive CUGH Awards

Ramanujam, Asiedu Receive the 2018 Velji Award for Global Health

Invented @ Duke

GWHT in Anno Review 2017

The Most Visually Stunning Science Stories of 2017

Cleaning Lab Equipment Leads to a Breakthrough Discovery

Engineering a New Narrative

Duke Celebrates Innovation and Entrepreneurship at the First Annual Invented at Duke Celebration

A New Way to Help Prevent Cervical Cancer, Invented at Duke

Duke Inventors Show How Their Ideas Came to Market

The Speculum Finally Gets a Modern Redesign

See related teams, Pocket Colposcope: Analysis of Bringing Elements of Referral Services to Primary/Community Care (2018-2019) and Pocket Colposcope: Increased Distribution and Adoption (2016-2017)

Themes

Faculty/Staff Team Members

Megan Huchko, School of Medicine-Obstetrics and Gynecology*
Marlee Krieger, Pratt School of Engineering-Biomedical Engineering*
Ernesto Ortiz, Duke Global Health Institute*
Rae Jean Proeschold-Bell, Duke Global Health Institute*
Nimmi Ramanujam, Pratt School of Engineering-Biomedical Engineering*

Graduate Team Members

Mercy Asiedu, Biomedical Engineering-PHD
Claire Edelman, Medicine-MD
Emily Mason, Business Administration-MBA

Undergraduate Team Members

Kayla Corredera-Wells
Ryan Fitzgerald, Biology (BS), Global Health (AB2)
Kiera Lunn, Evolutionary Anthropology (BS)
Siera Lunn
Cecelia Mizelle, Biology (BS)

* denotes team leader

Status

Active