Mitchell Emma McKim, Doede Aubrey L, McLean Estrada Michelet, Granera Orlando Benito, Maldonado Francisco, Dunn Brian, Banks Shernai, Marks-Symeonides Imani, Morrone Danielle, Pitt Charlotte, Dillingham Rebecca A
University of Virginia School of Nursing, Charlottesville, Virginia, USA.
Fundacion Movicancer, Managua, Nicaragua.
Telemed Rep. 2021 Nov 5;2(1):264-272. doi: 10.1089/tmr.2021.0024. eCollection 2021.
Cervical cancer, a preventable cancer of disparities, is the primary cause of cancer death for women in Nicaragua. Clinics and personnel in rural and remote Nicaragua may not be accessible to perform recommended screening or follow-up services. To assess acceptability and feasibility of integrating innovations for high-quality screening and treatment follow-up (tele-colposcopy) into existing pathways on Nicaragua's Caribbean Coast within the context of the National Cervical Cancer Control Program. Provider focus groups, key informant interviews, and environmental scans were conducted for 13 clinics on the Caribbean Coast of Nicaragua. Topics discussed included a smartphone-based mobile colposcope (MobileODT hardware and mobile platform), mobile connectivity capacity, clinic resources, provider acceptability, and current diagnostic and clinical protocols. We tested device connectivity through image upload availability and real-time video connection and simulated clinical encounters utilizing MobileODT and a low-cost cervical simulator. We developed a database of colposcopic images to establish feasibility of integrating this database and clinical characteristics into the cervical cancer registry. Provider acceptability of integrating tele-colposcopy into existing cancer control efforts was high. Image upload connectivity varied by location (mean = 1 h 9 min). Most clinics had running water (84.6%) and consistent electricity (92.3%), but some did not have access to landline telephones (53.8%). As faster connectivity becomes available in remote settings, Mobile Health tools such as tele-colposcopy will be increasingly feasible to provide access to high-quality cervical cancer follow-up. World Health Organization guidance on integrating technology into existing programs will remain important to ensure programmatic efficacy, local relevance, and sustainability.
宫颈癌是一种存在差异的可预防癌症，是尼加拉瓜女性癌症死亡的主要原因。尼加拉瓜农村和偏远地区的诊所及人员可能无法提供推荐的筛查或后续服务。在国家宫颈癌控制项目的背景下，评估将高质量筛查和治疗随访创新措施（远程阴道镜检查）整合到尼加拉瓜加勒比海岸现有途径中的可接受性和可行性。对尼加拉瓜加勒比海岸的13家诊所进行了提供者焦点小组、关键信息访谈和环境扫描。讨论的主题包括基于智能手机的移动阴道镜（MobileODT硬件和移动平台）、移动连接能力、诊所资源、提供者可接受性以及当前的诊断和临床方案。我们通过图像上传可用性和实时视频连接测试了设备连接性，并利用MobileODT和低成本宫颈模拟器模拟临床会诊。我们建立了一个阴道镜图像数据库，以确定将该数据库和临床特征整合到宫颈癌登记册中的可行性。提供者对将远程阴道镜检查整合到现有癌症控制工作中的接受度很高。图像上传连接性因地点而异（平均 = 1小时9分钟）。大多数诊所都有自来水（84.6%）和稳定的电力供应（92.3%），但一些诊所无法使用固定电话（53.8%）。随着偏远地区连接速度加快，远程阴道镜等移动健康工具将越来越可行，以提供高质量宫颈癌随访服务。世界卫生组织关于将技术整合到现有项目中的指导意见对于确保项目有效性、地方相关性和可持续性仍然很重要。
