Innovative approaches to cervical cancer prevention in Mozambican women receiving family planning services

Funding Agency:

USAID

Collaborators:

Rebecca Richards-Kortum (Rice), Kathleen Schmeler (UTMDACC), Ellen Baker (UTMDACC)

Overview:

Mozambique has one of the highest burdens of cervical cancer (CC) in the world and has a shortage of medical providers with only three doctors per 100,000 people, only 15 pathologists (1 per 2 million) and three medical oncologists (1 per 9 million) in the entire country. Currently in Mozambique, <5% of eligible women are undergoing cervical screening. Current challenges include limited screening coverage of the population, lack of public education regarding cervical screening, and few health care providers trained to diagnose and treat precancerous lesions. A recent project supported by the Bill & Melinda Gates Foundation (BMGF) integrated cervical screening and preventive therapy (CCS&PT) into voluntary Family Planning (FP) programs in Kenya, Nigeria, Tanzania, and Uganda. It resulted in an increase in the use of both FP and CCS&PT services, with >1.8 million cervical screenings and 25,727 cryotherapy treatments performed. To reduce the high burden of CC and unintended pregnancies in Mozambique, we propose to implement innovative models integrating CCS&PT within voluntary FP programs.

As part of this program, we will evaluate the feasibility and efficacy of two new, novel technologies developed for cervical screening and diagnosis. We will evaluate two novel POC technologies: 1) a low-cost, sensitive test for high-risk HPV DNA that can be performed at the POC in <1 hour; and 2) a rugged, portable multi modal optical imaging system with automated image analysis to detect cervical precancer and early cervical cancer invivo in screen-positive women. Our innovations combine advances in highly sensitive molecular diagnostics together with advances in deep learning and image analysis to yield cost-effective, accurate tools to improve the continuum of care for CCS&PT in LMICs. Our approach is based on a sensitive lateral flow test to detect high-risk HPV DNA that can be performed by nurses and community health care workers. At <$2/test, our approach has the potential to enable sustainable and scalable HPV-related cervical screening programs. Moreover, it does not require extensive laboratory equipment or a skilled technician. To enable effective cervical dysplasia detection at the POC, we also propose to evaluate a rugged multi-modal optical imaging system that is as affordable and as simple to use as a cell phone; the system acquires colposcopic images of the cervix and high-resolution images of cervical lesions and uses deep learning algorithms to accurately identify high grade cervical precancer.