Gormley, Rachel H

Kovarik, Carrie L

Quinley, Kelly E

Ramogola-Masire, Doreen

Shih, Ting

Steiner, Ann

Szep, Zsofia

English

PubMed

Rachel H Gormley

Kelly E Quinley

Ting Shih

Zsofia Szep

Ann Steiner

Doreen Ramogola-Masire

Carrie L Kovarik

Springer - Publisher Connector

Use of mobile telemedicine for cervical cancer screening of HIV-positive women in Gaborone, Botswana

MEETING ABSTRACTS Open Access
Use of mobile telemedicine for cervical cancer
screening of HIV-positive women in Gaborone,
Botswana
Rachel H Gormley1, Kelly E Quinley1, Ting Shih2, Zsofia Szep3, Ann Steiner4, Doreen Ramogola-Masire5,
Carrie L Kovarik3,6*
From 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies
(ICMAOI)
Bethesda, MD, USA. 26-27 April, 2010
Introduction and aims
Throughout the developing world, delivery of women’s
health care, specifically cervical cancer screening, is lim-
ited by cost and access to trained personnel. Visual
inspection with application of 4% acetic acid (VIA) is a
practical, inexpensive alternative to cytology-based
screening in areas where resources are limited. Mobile
telemedicine using a cellular phone to photograph the
cervix after VIA allows clinicians in “see and treat” cer-
vical cancer screening clinics to capture high-quality
images of the cervix, which can then be transmitted
through the cellular network to a gynecology specialist
located remotely. We present results of a prospective
case-control study evaluating the accuracy of offsite
(remote) expert diagnosis using mobile telemedicine
photographic images of the cervix with VIA (PIA) in
HIV-positive women in Gaborone, Botswana.
Methods and design
ClickDiagnostics has developed software (ClickDoc) spe-
cifically for remote diagnosis with the Samsung Soul
U900 phone, which comes equipped with a 5 Megapixel
camera. Ninety-five women presenting to Bontleng
Clinic were enrolled and had (1) VIA evaluation by an
onsite clinician, (2) an HPV (human papillomavirus)
sample taken for PCR (polymerase chain reaction), (3)
cervical photos taken with the Samsung phone camera,
and (4) photos evaluated by original onsite clinician and
by a remote gynecology specialist blinded to the initial
visit. VIA and PIA results were categorized as “positive,”
“negative,” or “indeterminate.” Percent agreement will
be calculated for each pair of diagnostic impressions: (1)
offsite gynecologist PIA to onsite clinician using VIA,
(2) onsite clinician PIA to the same onsite clinician
using VIA, (3) offsite gynecologist PIA to onsite clini-
cian PIA. The HPV PCR results will also be compared
to VIA findings of the onsite clinician and the PIA find-
ings of the offsite gynecologist.
Results
All 95 subjects have been enrolled and final data analy-
sis is currently under way. Preliminary concordance data
will be presented, along with HPV correlation and pre-
valence data from PCR testing. We hypothesize that
there will be significant concordance in the diagnosis of
cervical lesions in HIV patients, when comparing the
diagnosis of the onsite clinician to the diagnosis of the
clinician evaluating the photos through telemedicine.
Conclusions
Women in sub-Saharan Africa often present with
advanced cervical cancer, which is a result of poor
screening, lack of appropriate referral, and HIV-HPV
co-infection. In order to improve the availability of cervi-
cal cancer screening in Botswana, we propose the use of
mobile telemedicine as an adjunct tool to visual screen-
ing techniques for cervical cancer. We aim to show that
mobile telemedicine technology is a reliable method for
diagnosing cervical lesions compared to in-person gyne-
cological evaluation and that use of this technology has
the potential to connect resource-poor cancer screening
centers to remotely located gynecologists.
*Correspondence: carrie.kovarik@uphs.upenn.edu
3Department of Medicine, Division of Infectious Diseases, University of
Pennsylvania Medical Center, Philadelphia, PA, USA
Full list of author information is available at the end of the article
Gormley et al. Infectious Agents and Cancer 2010, 5(Suppl 1):A86
http://www.infectagentscancer.com/content/5/S1/A86
© 2010 Kovarik et al; licensee BioMed Central Ltd.
Acknowledgements
This article has been published as part of Infectious Agents and Cancer
Volume 5 Supplement 1, 2010: Proceedings of the 12th International
Conference on Malignancies in AIDS and Other Acquired
Immunodeficiencies (ICMAOI). The full contents of the supplement are
available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.
Author details
1University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 2Click
Diagnostics, Boston, MA, USA. 3Department of Medicine, Division of
Infectious Diseases, University of Pennsylvania Medical Center, Philadelphia,
PA, USA. 4Department of Obstetrics and Gynecology, University of
Pennsylvania Medical Center, Philadelphia, PA, USA. 5Botswana-UPenn
Partnership, Women’s Health Initiative, Gaborone, Botswana. 6Department of
Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA,
USA.
Published: 11 October 2010
doi:10.1186/1750-9378-5-S1-A86
Cite this article as: Gormley et al.: Use of mobile telemedicine for
cervical cancer screening of HIV-positive women in Gaborone,
Botswana. Infectious Agents and Cancer 2010 5(Suppl 1):A86.
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Gormley et al. Infectious Agents and Cancer 2010, 5(Suppl 1):A86
http://www.infectagentscancer.com/content/5/S1/A86
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Use of mobile telemedicine for cervical cancer screening of HIV-positive women in Gaborone, Botswana

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