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eC3-A Modern Telecommunications Matrix for Cervical Cancer Prevention in Zambia

Parham, Groesbeck P. MD1,2,3; Mwanahamuntu, Mulindi H. MBBCh, MMed1,2; Pfaendler, Krista S. MD1,4; Sahasrabuddhe, Vikrant V. MBBS, DrPH5; Myung, Daniel AB6; Mkumba, Gracilia MD1,2; Kapambwe, Sharon MD, MPH1,2; Mwanza, Bianca BSc1; Chibwesha, Carla MD, MSc1,3; Hicks, Michael L. MD7; Stringer, Jeffrey S.A. MD1,3

Journal of Lower Genital Tract Disease: July 2010 - Volume 14 - Issue 3 - p 167-173
doi: 10.1097/LGT.0b013e3181cd6d5e
ORIGINAL ARTICLES

Objectives. Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa.

Materials and Methods. We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world's poorest countries.

Results. Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic cervical cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation.

Conclusions. The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.

An electronic telecommunication system using appropriate technology bridges the gap between screening and diagnosis, thereby facilitating "screen-and-treat" programs for cervical cancer prevention.

1Center for Infectious Disease Research in Zambia, Lusaka, Zambia; 2University Teaching Hospital, Lusaka, Zambia; 3University of Alabama at Birmingham, Birmingham, AL; 4University of Cincinnati, Cincinnati, OH; 5Vanderbilt University, Nashville, TN; 6Dimagi, Inc, Charlestown, MA; and 7Michigan Cancer Institute, Pontiac, MI

Reprint requests to: Groesbeck P. Parham, MD, Center for Infectious Disease Research in Zambia, Plot No. 5977 Benekale Rd, Northmead, Lusaka, Zambia. E-mail: groesbeck.parham@cidrz.org; doctorparham@hotmail.com

This study was supported by the President's Emergency Plan for AIDS Relief grant through the Elizabeth Glaser Pediatric AIDS Foundation from the Centers for Disease Control and Prevention Global AIDS Program with additional support from the Fogarty International Clinical Research Scholars Program and Vanderbilt-CIDRZ AIDS International Training and Research Program (National Institutes of Health grants R24TW007988 and D43TW001035).

©2010The American Society for Colposcopy and Cervical Pathology