Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening Among HIV-Positive Women in Western Kenya
| Autor: | Benard O Samba, Craig R. Cohen, Catherine A Ochieng, Chemtai Mungo, Magdalene Randa, Jackton Omoto, Emily Barker, Jeniffer Ambaka, Anagha Guliam, Cirilus Ogollah Osongo |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Oncology Cancer Research medicine.medical_specialty MEDLINE Human immunodeficiency virus (HIV) Uterine Cervical Neoplasms HIV Infections Diagnostic accuracy Cervical cancer screening Cervical intraepithelial neoplasia medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Human papillomavirus Early Detection of Cancer Gynecologic Cancer Extramural business.industry ORIGINAL REPORTS Uterine Cervical Dysplasia medicine.disease Kenya 030220 oncology & carcinogenesis Feasibility Studies Female Smartphone Cervicography business |
| Zdroj: | JCO global oncology, vol 7, iss 7 JCO Global Oncology |
| Popis: | PURPOSE Adjunct cervical cancer screening methods are under evaluation to improve the diagnostic accuracy of human papillomavirus (HPV)-based screening in low- and middle-income countries. We evaluated the feasibility and acceptability of smartphone-based cervicography among HPV-positive women living with HIV (WLWH) in Western Kenya. METHODS HPV-positive WLWH of 25-49 years of age enrolled in a clinical trial (ClinicalTrials.gov identifier: NCT04191967 ) had digital images of the cervix taken using a smartphone by a nonphysician provider following visual inspection with acetic acid. All participants had colposcopy-directed biopsy before treatment. Cervical images were evaluated by three off-site colposcopists for quality, diagnostic utility, and assigned a presumed diagnosis. We determined the proportion of images rates as low, medium, or high quality, interobserver agreement using Cohen’s Kappa statistic, and the off-site colposcopist’s sensitivity and specificity for diagnosis of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared with histopathology. Acceptability was evaluated using a questionnaire. RESULTS One hundred sixty-four HPV-positive WLWH underwent cervicography during the study period. Mean age was 37.3 years. Images from the first 94 participants were evaluated by off-site colposcopists, with a majority (70.9%) rated as high quality. Off-site colposcopists had a sensitivity ranging from 21.4% (95% CI, 0.06 to 0.43) to 35.7% (95% CI, 0.26 to 0.46) and a specificity between 85.5% (95% CI, 0.81 to 0.90) to 94.9% (95% CI, 0.92 to 0.98) for diagnosis of CIN2+ based compared with histopathology. The majority of women, 99.4%, were comfortable having an image of their cervix taken as part of screening. CONCLUSION Cervicography by a nonphysician provider as an adjunct to HPV-based screening among WLWH in a low- and middle-income country setting is feasible and acceptable. However, low sensitivity for diagnosis of CIN2+ by off-site expert colposcopists highlights the limitations of cervicography. |
| Databáze: | OpenAIRE |
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