Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening Among HIV-Positive Women in Western Kenya.
Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening Among HIV-Positive Women in Western Kenya.
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DOI：
10.1200/go.21.00013
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发表时间：
2021-05
影响因子：
4.5
通讯作者：
Cohen CR
中科院分区：
文献类型：
--
作者：
Mungo C;Osongo CO;Ambaka J;Randa MA;Samba B;Ochieng CA;Barker E;Guliam A;Omoto J;Cohen CR
正在评估辅助宫颈癌筛查方法，以提高低收入和中等收入国家基于人乳头瘤病毒 (HPV) 的筛查的诊断准确性。我们评估了肯尼亚西部 HPV 阳性艾滋病毒感染者 (WLWH) 进行基于智能手机的宫颈造影的可行性和可接受性。参加临床试验（ClinicalTrials.gov 标识符：NCT04191967）的 25-49 岁 HPV 阳性 WLWH 由非医生提供者使用智能手机拍摄宫颈数字图像，然后用乙酸进行目视检查。所有参与者在治疗前均进行了阴道镜引导活检。由三名异地阴道镜医师对宫颈图像的质量、诊断实用性进行评估，并指定推测的诊断。与组织病理学相比，我们确定了低、中或高质量图像速率的比例、使用 Cohen Kappa 统计的观察者间一致性，以及场外阴道镜医师诊断 2 级或更严重的宫颈上皮内瘤变 (CIN2+) 的敏感性和特异性。使用问卷评估可接受性。在研究期间，164 名 HPV 阳性 WLWH 接受了宫颈造影。平均年龄为 37.3 岁。前 94 名参与者的图像由场外阴道镜专家进行评估，大多数 (70.9%) 被评为高质量。场外阴道镜检查的敏感性为 21.4%（95% CI，0.06 至 0.43）至 35.7%（95% CI，0.26 至 0.46），特异性为 85.5%（95% CI，0.81 至 0.90）至 94.9%（95% CI，0.92 至 0.98）。 CIN2+ 的诊断基于与组织病理学的比较。大多数女性（99.4%）对于拍摄宫颈图像作为筛查的一部分感到满意。在低收入和中等收入国家，由非医生提供的宫颈造影作为 WLWH 中 HPV 筛查的辅助手段是可行且可接受的。然而，异地阴道镜专家诊断 CIN2+ 的敏感性较低，凸显了宫颈造影的局限性。
Adjunct cervical cancer screening methods are under evaluation to improve the diagnostic accuracy of human papillomavirus (HPV)-based screening in low- and middle-income countries. We evaluated the feasibility and acceptability of smartphone-based cervicography among HPV-positive women living with HIV (WLWH) in Western Kenya. HPV-positive WLWH of 25-49 years of age enrolled in a clinical trial (ClinicalTrials.gov identifier: NCT04191967) had digital images of the cervix taken using a smartphone by a nonphysician provider following visual inspection with acetic acid. All participants had colposcopy-directed biopsy before treatment. Cervical images were evaluated by three off-site colposcopists for quality, diagnostic utility, and assigned a presumed diagnosis. We determined the proportion of images rates as low, medium, or high quality, interobserver agreement using Cohen’s Kappa statistic, and the off-site colposcopist’s sensitivity and specificity for diagnosis of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared with histopathology. Acceptability was evaluated using a questionnaire. One hundred sixty-four HPV-positive WLWH underwent cervicography during the study period. Mean age was 37.3 years. Images from the first 94 participants were evaluated by off-site colposcopists, with a majority (70.9%) rated as high quality. Off-site colposcopists had a sensitivity ranging from 21.4% (95% CI, 0.06 to 0.43) to 35.7% (95% CI, 0.26 to 0.46) and a specificity between 85.5% (95% CI, 0.81 to 0.90) to 94.9% (95% CI, 0.92 to 0.98) for diagnosis of CIN2+ based compared with histopathology. The majority of women, 99.4%, were comfortable having an image of their cervix taken as part of screening. Cervicography by a nonphysician provider as an adjunct to HPV-based screening among WLWH in a low- and middle-income country setting is feasible and acceptable. However, low sensitivity for diagnosis of CIN2+ by off-site expert colposcopists highlights the limitations of cervicography.