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500,000名妇女的生活，并导致超过270,000人死亡。75%以上的宫颈癌发病发生在非洲，其中东非发病率最高。在东非，尤其是坦桑尼亚，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)筛查。因此，醋酸目视检查(VIA)被用来在初级卫生保健环境中对普通女性人群进行筛查，VIA然后在二级(地区和地区医院)和三级医院进行冷冻治疗或环状电外科程序(LEEP)，VIA不需要像巴氏涂片或HPV检测那样的样本收集或处理，这使得它特别适合在这种环境中使用。在美国，对于已经筛查并发现巴氏涂片阳性的妇女，使用被称为镜的低倍显微镜进行放大VIAM。放大(4-7倍)被用来显示宫颈上的细微特征，在窥镜的帮助下暴露出来。然而，镜的价格(1万-20000美元)使得它在坦桑尼亚的使用变得令人望而却步。因此，在初级和二级健康设置中，VIA在不放大的情况下执行，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很低，每45000人中有1名医生，每2800人中有1名社区卫生工作者。此外，社区卫生工作者进行基于内窥镜的检查和解释他/她所看到的内容所需的培训需要每名妇女高达30美元，但结果参差不齐，导致更多妇女被夸大为VIA阳性。此外，有充分的研究表明，坦桑尼亚的妇女害怕宫颈检查中的窥镜和隐私的丧失。这一学术-产业合作伙伴关系的目标是让PI、Nimmi Ramanujam博士与Zenalux Biomedical合作，带来一项具有文化相关性的双管齐下的宫颈癌筛查计划，该计划将促进东非人口范围筛查的规模和SEE和TREAT计划的可持续性。

 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.