« Previously: Mobile colposcope makes cervical cancer testing handy  

January is considered to be Cervical Health Awareness Month, and this year, that designation has special significance for Nimmi Ramanujam, professor of biomedical engineering and global health and director of the Centre for Global Women’s Health Technologies. Incidentally, 20 of these devices were produced for distribution to international partners.

The pocket colposcope is currently being used in clinical investigations in hospitals in the United States (112 patients), Peru (149 patients), Kenya (100 patients) and Tanzania (27 patients), and will soon be implemented in studies in Honduras.

 
Duke Pocket Colposcope function buttons 4 (cr) Figure 1: The controls on the pocket colposcope were designed to be easy to use with one hand during the examination.  

Ramanujam will present the team’s findings in Lima, Peru, in May, as she and her team are currently working through the regulatory process for the pocket colposcope. Part of this research is to secure further grants and engage more students and faculty. In fact, this spring and summer, through the Bass Connections programme at Duke, a faculty-student research team will be exploring how to increase adoption, distribution and acceptance of the device in Peru.

Partners are integral to the colposcope’s success.

The Duke team couldn’t have gotten this far without the help of a network of collaborators who have been using and providing feedback on earlier versions of the pocket colposcope from Peru to India.

The Duke team is trying to form new partnerships for population-level studies in low and middle income countries. “Our partners who use the device in their communities are the ones who will demonstrate its impact to prevent cervical cancer,” said Ramanujam.

One such partner is Jose Jeronimo, senior advisor for women's cancers at PATH, who has been working closely with Ramanujam’s team since the beginning of this project. “The only way we will reduce the burden of cervical cancer in developing countries is by creating simple devices at an affordable price that can be deployed in areas with limited resources,” said Jeronimo, who has used previous versions of the device in research studies in the field. “The Pocket Colposcope is one brilliant device that fits perfectly with the work we need to do in those areas. Millions of women will benefit from this device, and many lives will be saved.”

Addressing needs beyond the colposcope

The team’s work hasn’t ended at the colposcope. Using a human-centred design process—an approach driven by the needs identified by individuals who will be using the product—they’ve developed a more woman-centric replacement for a traditional speculum. Traditional speculums can be uncomfortable, and women’s aversion to them can be a barrier to seeking care, so a more comfortable instrument could increase screening uptake. The device is currently in clinical testing; in a volunteer study, it was strongly preferred over the speculum.

 
Duke Pocket Colposcope size comparison Fig5 (cr) Figure 2: The speculum-free inserter next to a penny, shown for scale.  

The team is also developing a low-cost cervical cancer treatment that delivers gelatinous ethanol to the lesion site. This method does not need electricity or hard-to-obtain products that are required for traditional treatment approaches.

“Many people in low-resource settings don’t have access to cervical cancer treatment,” said Ramanujam, “so we can’t just develop screening technologies. We have to think through the entire process and see what we can do to make screening and treatment options available.”

 
« Previously: Mobile colposcope makes cervical cancer testing handy