Evaluating smartphone strategies for reliability, reproducibility, and quality of VIA for cervical cancer screening in the Shiselweni region of Eswatini: A cohort study

PLoS Medicine
Ramin AsgaryBernhard Kerschberger

Abstract

Cervical cancer is among the most common preventable cancers with the highest morbidity and mortality. The World Health Organization (WHO) recommends visual inspection of the cervix with acetic acid (VIA) as cervical cancer screening strategy in resource-poor settings. However, there are barriers to the sustainability of VIA programs including declining providers' VIA competence without mentorship and quality assurances and challenges of integration into primary healthcare. This study seeks to evaluate the impact of smartphone-based strategies in improving reliability, reproducibility, and quality of VIA in humanitarian settings. We implemented smartphone-based VIA that included standard VIA training, adapted refresher, and 6-month mHealth mentorship, sequentially, in the rural Shiselweni region of Eswatini. A remote expert reviewer provided diagnostic and management feedback on patients' cervical images, which were reviewed weekly by nurses. Program's outcomes, VIA image agreement rates, and Kappa statistic were compared before, during, and after training. From September 1, 2016 to December 31, 2018, 4,247 patients underwent screening; 247 were reviewed weekly by a VIA diagnostic expert. Of the 247, 128 (49%) were HIV-positive...Continue Reading

References

Jan 25, 2003·BMJ : British Medical Journal·David M Kaufman
Mar 19, 2003·Lancet·L GaffikinUNKNOWN Royal Thai College of Obstetricians and Gynaecologists (RTCOG)/JHPIEGO Corporation Cervical Cancer Prevention Group [correct
Sep 25, 2003·International Journal of Cancer. Journal International Du Cancer·Anthony B MillerCecilia Sepulveda
Feb 4, 2014·International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists·Kathryn S HandlogtenDaniel Ansong
Jun 4, 2014·International Journal of Cancer. Journal International Du Cancer·Megan J HuchkoCraig R Cohen
Jul 1, 2014·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Allen C BatemanCarla J Chibwesha
Feb 7, 2016·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Reem A MustafaHolger J Schünemann
Apr 1, 2016·Journal of Lower Genital Tract Disease·Ramin AsgaryOlugbenga Ogedegbe
Nov 7, 2016·Lancet·Ophira GinsburgLesong Conteh

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Methods Mentioned

BETA
biopsy

Software Mentioned

STATA
JHPIEGO

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