Pocket Colposcope: Analysis of Bringing Elements of Referral Services to Primary/Community Care
July 01, 2018 - December 01, 2019
Invasive cervical cancer affects 500,000 women worldwide each year. Unlike most cancers, it is highly preventable through the screening, diagnosis and treatment of cervical precursor lesions.
Colposcopy with biopsy is the gold standard for diagnosis of precancerous lesions. However, colposcopes are expensive, and require referral to a facility that can house this machine as well as a trained colposcopist who can interpret the images. These factors make colposcopy inaccessible to the many women in low- and middle-income countries who are at greatest risk for developing cervical cancer.
To address this limitation, Duke researchers have developed a device called the Pocket Colposcope. It is more than an order of magnitude less expensive and lighter than commercial colposcopes. The first year of this Bass Connections project in 2016-17 was dedicated to performing a global value chain analysis in order to identify leverage points that can increase the likelihood of adoption of the Pocket Colposcope in Peru. In 2017-18, team members focused on launching a community health provider program to implement the Pocket Colposcope at the primary care setting in Peru.
This Bass Connections project seeks to understand the best practices for creating a training program for community-level providers and to develop a training manual based on feedback from community health providers working with La Liga Contra el Cancer. The project team will engage in an in-country field experience in Lima and surrounding areas of Huancayo, Huanuco and Cusco, for a preliminary field testing of training strategies.
The team’s goal is to demonstrate that the Pocket Colposcope is an economically viable solution in the community health setting. Team members will conduct a cost-effectiveness analysis to determine the incremental cost-effectiveness ratio of the team’s approach relative to %u201Cscreen and treat%u201D with no triage (World Health Organization guidelines) and a high-resource strategy of treating based on biopsy result. They will use micro-costing to estimate several indices comparing costs to desired program outcomes: cost per case of CIN detected; cost per triage visit; and cost per woman treated. The team will also construct a decision model to estimate the health impact of HPV screening, triage and follow-up with appropriate treatment. This model will portray the paths from HPV to detection, the risks of clinical progression and outcomes with and without treatment.
Team members will use the decision-analysis model to assess the incremental cost-effectiveness ratio (ICER) when comparing triage strategies, and calculate the ICER compared to the current standard. They will look at staffing models and efficiency levels obtained through primary provider use of the Pocket Colposcope, and estimate the costs for scaled-up replication.
Anticipated Outcomes include: Mid-year report on progress to date and research plan; cost-effectiveness model; final report with recommendations
Team leaders seek 5-7 undergraduates and 2-4 graduate/professional students. Specific backgrounds are open; possible fits include engineering, global health, medicine, public policy, business, law, women’s studies and/or Spanish studies. While fluency in Spanish is not required, at least 50% of the team should be Spanish speaking.
The project will facilitate learning through weekly meetings that cover three topic areas: cervical cancer screening and healthcare systems in Peru; best practices in training and the assessment of training of community health providers; and cost-effectiveness analysis.
Team members will gain exposure to developing and implementing technologies, and learn about the intersection between engineering, social sciences and microeconomics. Members will also experience local-global comparisons and connections; team leaders have an ongoing IRB-approved clinical study to test the Pocket Colposcope in patients undergoing cervical cancer screening at Duke University Medical Center, and participants can be involved in this Durham-based research as well as the Peruvian research. We will compare and contrast the two sites during team meetings.
Evaluation of students will be based on presentations and participation in weekly meetings, weekly blog posts, research and data analysis and mid-term and final reports. Students will also be expected to submit an e-portfolio that documents the work they did and a final reflection statement that emphasizes global awareness, civic literacy, critical thinking, problem solving, creativity, life/team and interpersonal skills. An additional evaluation will be performed on preparedness of students for the international trip with respect to learning cultural, social and language skills.
Project Application Process
Please submit your application through the Bass Connections Website (bassconnections.duke.edu). Questions about this team should be directed to Marlee Krieger.
Project Selection Criteria
Spanish (50% of selected team members will need to be Spanish speaking)