Feasibility and Outcome of Training Field Workers to Use the Transvaginal Colposcope for Point of Care Diagnosis and Management of Precancerous Cervical Lesions

Background: Screening programs in low-middle-income countries have high attrition rates during referral and treatment. Portable colposcopes can decrease costs, reduce referral rates and improve compliance with treatment especially if performed at primary care facilities. The objective of the present study was to assess the ability of field workers (FW) to perform colposcopy. Methods: The study was conducted in two phases: In phase-1, women aged 21–65 years referred for colposcopy for an abnormal screening report or cervical symptoms were enrolled, underwent visual inspection with acetic acid (VIA) and colposcopy. The performance of FW in capturing colposcopic images using a transvaginal colposcope (TVC) was analysed and compared with those captured by a physician using TVC and digital video colposcope. In phase-2, an experienced FW and a new FW captured images of the cervix from 100 women with TVC, and the images were assessed by colposcopist. Findings: Among 125 subjects enrolled, 96 (76.8%) were VIA positive and 12 (9.6%) had CIN2+ lesions. Of the images captured by FW, 122 (97.6%) were adequate for interpretation. Swede score calculated from the images captured by FW and the physician showed high level of agreement (K = 1.0). On image review, FW and colposcopist recommended referral in 98 (78.4%) and 34 (27.2%) subjects, respectively. The images captured by both FW were reassessed and the Swede scores were same in 87% women with weighted k-value of 0.945 on histopathology correlation. Interpretation: TVC can be used by FW to capture cervical images which can be reviewed by colposcopist to reduce referral rates.

Duke Scholars

Author Nimmi Ramanujam Biomedical Engineering