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

基本信息

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
项目类别：
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

项目摘要

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（申请人提供）：宫颈癌每年影响全球 500,000 名女性的生活，导致超过 270,000 人死亡，超过 75% 的宫颈癌发病率发生在非洲，其中东非发病率最高。，特别是坦桑尼亚人乳头瘤病毒 (HPV) 检测（高度敏感）或巴氏涂片（高度特异性）筛查因此，初级卫生保健机构使用醋酸目视检查（VIA）对一般女性人群进行筛查，而二级（地区和地区医院）则进行 VIA 后进行冷冻疗法或循环电外科手术（LEEP）。在美国和三级医院，VIA 不需要像巴氏涂片或 HPV 检测那样进行样本采集或处理，这使得在美国，具有放大功能的 VIA 在这种情况下特别有吸引力。 (VIAM) 使用低倍显微镜（称为阴道镜）对已接受筛查并发现巴氏涂片呈阳性的女性进行，使用放大倍数 (4-7 倍) 来观察子宫颈上的细微特征，子宫颈暴露在外。然而，阴道镜的费用（10,000 至 20,000 美元）使其在坦桑尼亚的使用无法在初级和次级进行。卫生环境和 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高，每 45,000 人有 1 名医生，每 2,800 人有 1 名社区卫生工作者。社区卫生工作者进行基于窥器的检查并解释他/她所看到的情况，每名妇女需要花费 30 美元，但结果参差不齐，导致更多的妇女被夸大为 VIA 阳性。有据可查的研究表明，坦桑尼亚女性担心在宫颈检查中使用窥器和失去隐私。这项学术-工业合作伙伴关系的目标是让 PI Nimmi Ramanujam 博士与 Zenalux Biomedical 合作，带来两个-多管齐下的宫颈癌筛查计划与文化相关，将促进东非人口筛查的规模和“查看和治疗”计划的可持续性。