Automated Visual Evaluation for Cervical Cancer Screening in HIV-positive Women

项目摘要/总结： 即使接受抗逆转录病毒治疗，艾滋病毒阳性（艾滋病毒+）妇女患宫颈癌的风险也很高 疗法目前世界卫生组织的指南建议筛查和治疗人乳头瘤病毒 (HPV)DNA检测是低资源环境下宫颈癌筛查的最佳方法。然而，在这方面， HIV阳性妇女的HPV感染率异常高，这导致在筛查和治疗方法中， 严重的过度治疗需要的是一种简单的方法来分流HPV+HIV+女性。我们提出建设 关于开普敦大学和哥伦比亚大学之间二十多年的合作 调查如何在南非加强宫颈癌筛查。我们最近已经证明， 护理点HPVDNA测定可适用于HIV阳性妇女的筛查和治疗。我们建议 扩展这项工作，以调查是否新技术的自动视觉评价的数字图像的 子宫颈与HPV检测结合具有临床实用性。我们建议利用我们现有的临床研究 在开普敦建立了一个平台，招募艾滋病毒抗体阳性和阴性妇女，以解决以下两个具体问题： 目标。具体目标1将研究使用以下方法拍摄的数字图像的自动视觉评价的临床实用性 与其他替代方案相比，MobileODT平台作为HPV+HIV+女性的分诊评估方法， 包括HPV DNA检测、细胞学检查和专家阴道镜检查。具体目标2将研究临床 自动视觉评价作为一种评估方法的实用性，以检测以下女性的治疗失败： 已接受消融治疗程序作为前几轮筛查的一部分。过程中 开展这项临床研究，具体目标3将支持能力发展和培训， 在东开普省资源匮乏的地区评估有效的宫颈癌筛查技术， 南非的林波波省。这将通过联合国系统现有的能力发展举措来实现。 开普敦大学妇产科系。

Project Abstract/Summary: HIV-positive (HIV+) women are at high risk of developing cervical cancer even when treated with antiretroviral therapy. Current World Health Organization guidelines recommend screen-and-treat with human papilloma virus (HPV) DNA testing as the optimal approach for cervical cancer screening in low resource settings. However, HIV+ women have exceptionally high rates of HPV infection which lead, in the screen-and-treat approach, to substantial overtreatment. What is needed is a simple method to triage HPV+HIV+ women. We propose to build on more than two decades of collaboration between the University of Cape Town and Columbia University investigating how to strengthen cervical cancer screening in South Africa. We have recently demonstrated that a point-of-care HPV DNA assay can be adapted for screen-and-treat for HIV-positive women. We propose to extend this work to investigate whether new technologies of automated visual evaluation of digital images of the cervix have clinical utility in conjunction with HPV testing. We propose to utilize our established clinical research platform in Cape Town to recruit HIV-positive and HIV-negative women to address the following two specific aims. Specific Aim 1 will investigate the clinical utility of automated visual evaluation of digital images taken using the MobileODT platform as a triage assessment method for HPV+HIV+ women compared to other alternatives, including adaptation of HPV DNA tests, cytology and expert colposcopy. Specific Aim 2 will investigate the clinical utility of automated visual evaluation as an assessment method to detect treatment failure among women who have undergone ablative treatment procedures as part of prior rounds of screening. Over the course of undertaking this clinical study, Specific Aim 3 will support capacity development and training to implement and evaluate effective cervical cancer screening technologies into low resource settings within the Eastern Cape and Limpopo Provinces in South Africa. This will be done through existing capacity development initiatives in the Department of Obstetrics and Gynaecology at the University of Cape Town.