Culturally appropriate screening and diagnosis of cervical cancer in East Africa

东非文化上适宜的宫颈癌筛查和诊断

• 批准号: 8864360
• 负责人: Nirmala Ramanujam
• 金额: $ 63.29万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8864360
• 关键词: Acetic Acids; Affect; Africa; Algorithms; Benchmarking; Benign; Biopsy; Calibration; Cellular Phone; Cervical; Cervical Cancer Screening; Cervix Uteri; Cessation of life; Clinical Research; Cold Therapy; Colposcopes; Communities; Community Health; Consumption; Country; Devices; Diagnosis; Diagnostic; Disease; Dysplasia; Feedback; Female; Fright; Goals; Gold; Haiti; Hand; Health; Health Status; Hemoglobin; Hospitals; Human Papillomavirus; Image; Imagery; Incidence; Industry; Lesion; Light; Literature; Maintenance; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measurement; Measures; Mediating; Medical center; Methyl Green; Microscope; Modeling; Morphologic artifacts; Motion; Optics; Pap smear; Pathologist; Pathology; Pathway interactions; Patients; Performance; Persons; Phase; Physicians; Population; Prevalence; Primary Health Care; Privacy; Procedures; Process; Proprotein Convertase 1; Public Health; Recruitment Activity; Relative (related person); Research; Resources; Sensitivity and Specificity; Source; Specificity; Specimen Handling; Spectrum Analysis; Speculums; Speed; System; Tampons; Tanzania; Technology; Telemedicine; Testing; Tissues; Training; Vagina; Vision; Visit; Visual; Woman; Work; absorption; arm; base; cancer care; commercialization; cost; density; design; detector; digital; expectation; improved; industry partner; mortality; neovascularization; pressure; programs; public health relevance; research clinical testing; sample collection; screening; sensor; spectroscopic imaging; standard of care

 DESCRIPTION (provided by applicant): Cervical cancer affects the lives of 500,000 women worldwide each year, and results in more than 270,000 deaths. More than 75% of cervical cancer incidence occurs in Africa, of which East Africa has the highest. In East Africa, and in particular, Tanzania Human Papilloma Virus (HPV) testing (highly sensitive) or the Papanicolaou (Pap) smear (highly specific) screening is not available. Thus, visual inspection with acetic acid (VIA) is used to screen the general female population at a primary health care setting, and VIA followed by cryotherapy or Loop Electrosurgical Procedure (LEEP) is performed at secondary (district and regional hospitals) and tertiary hospitals, VIA does not require specimen collection or processing like the Pap smear or HPV test, which makes it particularly appealing for use in this setting. In the U.S., VIA with magnification (VIAM) is performed using a low power microscope, called the colposcope, in women who have already been screened and found to have positive Pap smears. Magnification (4- 7X) is used to visualize subtle features on the cervix, which is exposed with the aid of a speculum. However, the cost of the colposcope (U.S. $10K-$20K) makes its use in Tanzania prohibitive. VIA therefore is performed without magnification at the primary and secondary health settings and the interpretation of VIA is subjective. The problem with implementing VIA at the primary health setting is that health worker density in Tanzania is dire at 1 physician per 45,000 persons and 1 community health worker per 2,800 persons. Further, the training required for the community health worker to do a speculum based exam and interpretation of what he/she sees requires as much as $30 per woman with uneven results, leading to greater number of women that are overcalled as VIA positive. Further, there are well-documented studies that show that women in Tanzania fear the speculum and loss of privacy in a cervical exam. The goal of this Academic-Industry Partnership is for PI, Dr. Nimmi Ramanujam to work in partnership with Zenalux Biomedical to bring a two-pronged cervical cancer culturally relevant screening program that will facilitate scaling of population wide screening and sustainability of see and treat programs in East Africa.

 描述（由申请人提供）：宫颈癌每年影响全世界 500,000 名女性的生活，并导致超过 270,000 人死亡。 75%以上的宫颈癌发生在非洲，其中东非最高。在东非，特别是坦桑尼亚，无法进行人乳头瘤病毒 (HPV) 检测（高度敏感）或巴氏涂片（高度特异性）筛查。因此，醋酸目视检查（VIA）用于在初级卫生保健机构中对一般女性人群进行筛查，而VIA随后进行冷冻疗法或环形电外科手术（LEEP）在二级（地区和区域医院）和三级医院进行，VIA不需要像巴氏涂片或HPV检测那样的样本采集或处理，这使得它在这种情况下特别有吸引力。在美国，放大 VIA (VIAM) 是使用低倍显微镜（称为阴道镜）对已经接受筛查并发现巴氏涂片呈阳性的女性进行的。放大倍数 (4-7X) 用于可视化子宫颈上的细微特征，借助窥器将子宫颈暴露出来。然而，阴道镜的成本（1万至2万美元）使其在坦桑尼亚的使用令人望而却步。因此，VIA 在初级和二级卫生机构中进行时无需放大，并且 VIA 的解释是主观的。在初级卫生机构实施 VIA 的问题是，坦桑尼亚的卫生工作者密度非常严重，每 45,000 人有 1 名医生，每 2,800 人有 1 名社区卫生工作者。此外，社区卫生工作者进行窥镜检查和解释他/她所看到的情况所需的培训需要每名女性高达 30 美元，但结果参差不齐，导致更多女性被夸大为 VIA 阳性。此外，有充分记录的研究表明，坦桑尼亚女性害怕宫颈检查中的窥器和隐私丧失。这一学术-行业合作伙伴关系的目标是让 PI Nimmi Ramanujam 博士与 Zenalux Biomedical 合作，推出一个与文化相关的双管齐下的宫颈癌筛查计划，从而促进东非人口范围内筛查的扩大以及查看和治疗计划的可持续性。