How does the POCkeT Colposcope address the issues associated with care in LMICs?
Updated: Sep 5, 2019
Peru, like many other low-middle income countries (LMICs), has high incidence rate of cervical cancer. Cervical cancer is the most prevalent cancer in compare to other cancers in women of all ages, which calls for the increasing needs of effective and efficient screening and treatment methods. As 50-75% of women in LMICs are lost to follow-up after initial cervical cancer screening, the ASCCP has recommended the “see and treat” model for cervical cancer care.
In the “see and treat” paradigm, visual inspection with acetic acid is a critical step for the prevention or treatment of any women that come to the clinic. It is important to have adequate view of the squamocolumnar junction on the cervix, also known as “transformation zone”, to identify any precancerous and cancerous lesions. Acetic acid enables the high nuclear density area to show up as white lesion. A colposcope, which functions as a lighted binocular or monocular microscope to magnify the view, is used for the visual examination of the cervix. The current colposcope available for LMIC are digital cervicography and digital colposcopy. The digital cervicography lacks high magnification and requires an external light source and stand. The other option, digital colposcopy, is bulky and expensive. Both of which are costly and require extensive training. Thus these current technologies for cervical visual inspection with acetic acid (VIA) are still challenging to be widely adopted. The POCkeT colposcope fills a void in cervical cancer screening, offering a powerful combination of high specificity, portability, affordability, and low-maintenance and low-training requirement.
How could the existing design be improved?
The POCkeT Colposcope has been through several iterations and many of its features have already been studied in a laboratory setting. Over the many iterations of the device, there have been several improvements in the device itself ranging from compacting the technology to aesthetic and design choices. To further improve the device, it is logical to expand the scope of the research and begin to improve the many interfaces that the POCkeT device will have out in the field. One of the databases that has been created to complement the POCkeT Colposcope is the Research Electronic Data Capture (REDcap) platform. This encrypted database collects digital information and images captured through the POCkeT Colposcope to be used for later training and evaluation. While the REDcap platform is a vital complement to the POCKeT device we must also consider how to integrate this design and it’s technology to have a maximal impact. One idea for improving REDcap is to create a physical satellite site,
Additionally, the while the POCKeT device can work with a traditional speculum, an alternative speculum design that is complementary to the POCKeT should also be implemented. While researchers at Duke have been studying how to make a better speculum, the design should also consider how to make the experience less painful and intimidating for women. Since many of the concerns with using the POCKeT device had to do with privacy, created a complementary training program to teach women how to use the device at their own discretion would be an interesting area for improvement. In such a program, a healthcare professional can create a video (adapted to the appropriate language) to explain how to safely and correctly use the device so that women can use it in their own homes.
Another potential area of improvement is to rethink the way the device is distributed. If the device can be used by multiple women in the comfort of their own homes, then new sanitizing technologies also need to be developed. Currently, the device has been designed to be sterilized after each use in a clinical setting, as it is waterproof. However, disposable plastic covers or rubber covers may be a faster, cheaper and more reliable means of sanitization.
1. Lam, Christopher T. et al. “Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings.” PLOS ONE 10.9 (2015).