Cancer of the cervix is the fifth most common cancer among women worldwide. Cervical cancer is the second most common cancer after breast cancer at 19.3% and 20% of all reported cancers in Kenya, respectively (KEMRI, 2010). Cervical cancer is also the leading cause of death in women in Kenya.
Opportunities to prevent, cure and relieve suffering from cervical cancer exist through primary prevention of HPV infection, secondary prevention by screening, treatment of precancerous disease and early stages of cancer as well as tertiary care for women with invasive cancer.
In Kenya, it is estimated that only 3.2% of women aged 18-69 years have been screened in any 3-year period (WHO/ICO Information Centre on HPV and Cervical Cancer, 2010). Methods, such as DNA testing for human papillomavirus (HPV) and simple visual screening other than cytologic screening programs are more dependent on existing laboratory infrastructure may not serve the developing countries such as Kenya with constrained resources. Screening methods that can be incorporated into new strategies and would require fewer visits may prove more practical. Various tests have been recommended as screening methods in Kenya. They include Visual Inspection with Acetic Acid (VIA), Visual Inspection with Lugol’s iodine (VILI), Cytology using Conventional Pap smear and HPV testing. While VIA/VILI is widely used in developing countries, it has lower specificity (49-86%) compared to cytology.
A study comparing accuracy of different screening methods shows that screening with VIA or VILI allows detecting presence of cervical cancer and its precursors with an accuracy as good or even better than the standard Pap smear test or testing for the presence of high-risk HPV with HC2 assay (Arbyn M, 2008). Efforts by PS Kenya to contribute to an increase of accurate and accessible screening services, equipped 75 of its social franchise Tunza Facilities to offer screening and Treatment of pre-cancer lesions by use of VIA/VILI to screen and cryotherapy machines to treat the positive lesions.
Some of the challenges with VIA/VILI is inability to preserve images for possible consultation (quality assurance support) and for evidence based feedback to clients (visualization of the process). Many clients get influenced and make informed decisions when they visualize and internalize their health concerns. PS Kenya’s Strategy involves targeting women aged 30-49 with information on Cervical Cancer screening and treatment of pre-cancer lesions through static and outreach models. Research has shown that targeting this specific age group for screening is more cost effective (Arbyn M, 2008). Besides equipping the provider with skills and logistics, PS Kenya reinforced and established referral mechanisms for bigger lesions or suspicious cases that require further management.
In July 2016, PS Kenya approached Mobile ODT, a company that developed the Eva (Enhanced Visual Assessment) System (a system that uses technology to diagnose cervical cancer), for a possible partnership. In September of the same year, PS Kenya and Mobile ODT agreed to conduct a pilot that would run for a period of 3 months in 2 Tunza facilities i.e. Wama Nursing home in Rongai and Boores Clinic in Thika. This pilot entailed the use of the Eva system in these facilities to assess the effect of better visualization of precancerous cervical lesions to both the provider and client.
The Eva system is an image capturing device that used alongside VIA/VILI improves diagnosing of pre-cancerous lesions because visualization of the cervix is improved through magnification. The system provides the opportunity to capture images while performing cervical cancer screening using VIA/VILI and store in a cloud based data base for review at a later time. The captured images can therefore be shared for quality assurance support and mentorship so as to ensure clients are receiving the utmost level of care.The components of the Eva system that was used across the facilities are outlined below.
The Eva system is made up of 3 components i.e.
- Easy to use device: the Eva Scope is a mobile colposcope equipped with an ultra-bright light source and a powerful magnification lens for enhanced visualization.
- User friendly mobile App: the Eva App enables secure image capture and patient data tracking for remote consultation, patient tracking and improved referral and follow up.
- Cloud based information system: the Eva Cloud provides secure, everywhere access, to real time data to monitor provider utilization cases reviewed, anonymized patient statistics and intuitive tools to enhance quality control and quality improvement opportunities.
The pilot study showed an increased uptake of Cervical cancer screening as compared to an equivalent three month period. This is a 62 % and 16 % increase in Boore and Wama Nursing homes, this is a 58% average increase across the pilot sites.
After the pilot period, results showed that the EVA system aids in better visualization of precancerous cervical lesions. Providers also felt that it supports objective support supervision and improves the confidence of both the provider and the client in the screening process a well as treatment uptake. This is evident for the increase in uptake of cervical cancer screening services.