Abstract 90: Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening among HIV-Positive Women in Western Kenya

Abstract

Purpose: Adjunct cervical cancer screening methods, including cervicography, are under evaluation to improve the accuracy of HPV-based screening in low- and middle-income countries (LMICs). We evaluated the feasibility and acceptability of smartphone-based cervicography among HPV-positive women living with HIV (WLWH) in Western Kenya. Methods: HPV-positive WLWH age 25-49 years enrolled in a clinical trial (NCT04191967) had digital images of the cervix taken using a smartphone by a nonphysician provider following visual inspection with acetic acid (VIA). All participants had colposcopy-directed biopsy prior to treatment. A questionnaire was administered to assess acceptability of cervicography. Cervical images were evaluated by three off-site colposcopists for quality, diagnostic utility, and assigned a presumed diagnosis. We determined the proportion of images rated as low, medium, or high quality, the interobserver agreement using Cohen's Kappa statistic, and the colposcopist's sensitivity and specificity for diagnosis of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared with histopathology. Results: One hundred and sixty-four HPV-positive WLWH underwent cervicography during the study period. Mean age was 37.3 years. The vast majority of women, 99.4%, were comfortable having an image of their cervix taken as part of screening. Images from the first 94 participants were evaluated by off-site colposcopists, with a majority (70.9%) rated as high quality, and 86.9% of sufficient quality for diagnosis. Off-site colposcopists had a sensitivity ranging from 21.4% (95% CI 0.06-0.43) to 35.7% (95% CI 0.26-0.46), and specificity between 85.5% (95% CI 0.81-0.90) to 94.9% (95% CI 0.92-0.98) for diagnosis of CIN2+ compared to histopathology. Conclusion: Cervicography by a nonphysician provider as an adjunct to HPV-based screening among WLWH in an LMIC setting is feasible and acceptable. However, low sensitivity for diagnosis of CIN2+ from cervical images by off-site expert colposcopists highlights the limitations of cervicography and need for a better triage test in this population. Citation Format: Chemtai Mungo, Cyrillus Ogollah, Jennifer Ambaka, Magdalene Randa, Anagha Guliam, Craig Cohen. Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening among HIV-Positive Women in Western Kenya [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 90.