Cervical Cancer Screening in Madagascar Using Smartphone Photos and Mobile Telemedicine
Cervical Cancer Screening in Madagascar Using Smartphone Photos and Mobile Telemedicine
The purpose of this study is to determine whether smartphone photos may assist health-care
 worker (on-site) and to evaluate the diagnostic reliability and accuracy of cervical
 examination with smartphone photos of VIA (D-VIA), on-site and off-site, compared with
 conventional VIA, for human papillomavirus (HPV) positive women.
Background: Cervical cancer is the leading cause of cancer death in females in Madagascar. In
 this country, a large-scale screening of precancerous lesions with cytology is hardly
 possible, because of the lack of specialists and infrastructures. Visual inspection of the
 cervix with application of 5% acetic acid (VIA) is an inexpensive alternative but very
 subjective since it depends on the examiner's experience. Mobile telemedicine is a very
 promising tool in order to assist non-expert health-care workers in rural area for cervical
 cancer screening.

 Objective: To assess if Smartphone may assist health-care worker (on-site) and to evaluate
 the diagnostic reliability and accuracy of cervical examination with smartphone photos of VIA
 (D-VIA) compared with conventional VIA, for women testing positive for human papillomavirus
 (HPV).

 Material and method: On-site health care workers will be trained in VIA. Prescreened
 HPV-positive women will be referred to VIA evaluation, during which digital images with a
 smartphone (D-VIA) will be taken for later evaluation by a VIA specialist in Geneva linked by
 telemedicine. Women with positive VIA results will be treated with cold coagulation if
 eligible. Histological results will be considered as gold standard. The results will be
 analyzed with Cohen's kappa coefficient, Mcnemar's test and Bonferroni's adjustment for
 multiple comparisons to assess the performance of D-VIA.

 Expected results: Based on the results of this project, the investigators will develop an
 educational training and quality assurance program for health providers for VIA and so
 contribute to a scaling-up of cervical cancer control. An appropriate triage by VIA will
 reduce not only an excessive referral rate but also an excessive treatment delay, giving the
 possibility of a "screen (HPV), see (VIA/D-VIA), and treat" program in a single or two
 visits.
Inclusion Criteria:

 -  30-49 years

 -  HPV-positive

 -  Attending the cervical cancer screening program conducted by the Saint-Damien
 Health-Care Centre

 -  Understands study procedures and accepts voluntarily to participate by signing the
 informed consent form (ICF)

 Exclusion Criteria:

 -  Previous Hysterectomy

 -  Conditions that can interfere with visualization of the cervix

 -  Pregnancy > 20 weeks

 -  Not able to comply with protocol study.