Project Lead(s): Karen Yeates
Cervical cancer kills approximately 270,000 women every year, with 85% of these cases occurring in the developing world. In Sub-Saharan Africa (SSA), women die of cervical cancer at rates 10 times higher than in the developed world, due to the lack of early detection.
If found early, cervical cancer is completely curable through simple treatments, such as cryotherapy that can be provided by a trained nurse.
Cervical cancer screening programs utilize visual inspection, with acetic acid (VIA) as the screening method in low-resource settings. This method involves training of non-physician health providers, to allow screening to take place in a more widespread way and at the level of the community.
VIA programs face challenges with maintaining skills among providers, and in providing mentorship and supportive supervision for newly trained providers. These programs are expensive and this impacts on the ability of low-resource countries to scale these programs effectively and with quality screening.
Implemented in Tanzania, The Kilimanjaro Cervical Screening Project was an effectiveness study to test:
· the use of images from a 'smart' phone's camera to enhance visual inspection with acetic acid (the current method used for cervical cancer screening in low-resource settings) to mentor and train cervical cancer screening providers. This smart phone-enhanced VIA method (known as SEVIA) allows newly trained cervical cancer screening providers to share cervical images, along with their diagnosis and treatment plan, with expert reviewers in distant locations. This decreases the need for expensive supportive supervision and mentorship, where trainers or screening providers would need to travel to clinic sites to ensure the trained providers are providing high-quality services
The pilot study showed that cervical cancer screening providers were able to quickly learn how to obtain high-quality images after performing VIA. The images were shared through a mobile application on the phone with expert reviewers at a distant location. Between the diagnosis of the provider and the reviewer, agreement of over 95% was reached within one month of the launch of the program. The providers received ‘real time’ feedback while they were screening patients, which aided treatment decisions and allowed the providers to ‘screen and treat’ accurately at the time a woman was being screened.
The Kilimanjaro Cervical Cancer Screening Project has been an overwhelming success. The capacity-building component and engagement of the trained nurses at the semi-rural partner project site resulted in the development of a well-established program of cervical cancer screening that will continue beyond the life of the current grant.
The researchers intend to expand the program across the Kilimanjaro region and/or potentially into other training sites in Africa They anticipate training more than 80 providers in over 40 health facilities using a newly designed, custom-made smart phone application, to facilitate sharing of cervical images and treatment plans among screening providers and expert reviewers/trainers.