Culturally appropriate screening and diagnosis of cervical cancer in East Africa

 描述（申请人提供）：宫颈癌每年影响全球50万妇女的生活，并导致超过27万人死亡。超过75%的宫颈癌发病率发生在非洲，其中东非最高。在东非，特别是坦桑尼亚，没有人乳头瘤病毒（HPV）检测（高度敏感）或巴氏涂片（高度特异性）筛查。因此，在初级卫生保健机构使用醋酸目视检查（VIA）筛查一般女性人群，在二级（地区和区域医院）和三级医院进行VIA，然后进行冷冻疗法或环形电外科手术（LEEP），VIA不需要像巴氏涂片或HPV检测那样的标本收集或处理，这使得它特别适合在这种情况下使用。在美国，放大VIA（VIAM）是使用低倍显微镜，称为阴道镜，在妇女谁已经被筛选，并发现有积极的巴氏涂片。放大（4- 7倍）用于观察宫颈上的细微特征，宫颈在窥器的帮助下暴露。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望而却步。因此，在初级和二级卫生机构进行VIA时不需要放大，并且VIA的解释是主观的。在初级保健机构实施全面免疫援助的问题是，坦桑尼亚的保健工作者密度很低，每45 000人中有一名医生，每2 800人中有一名社区保健工作者。此外，社区卫生工作者进行窥镜检查和解释他/她所看到的内容所需的培训需要每名妇女30美元，结果参差不齐，导致更多的妇女被称为VIA阳性。此外，有充分记录的研究表明，坦桑尼亚妇女害怕在宫颈检查中使用窥镜和失去隐私。Nimmi Ramanujam博士将与Zenalux Biomedical合作，一项与文化相关的子宫颈癌筛查计划，将促进扩大人口范围的筛查和东部地区“看和治疗”计划的可持续性非洲

 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.