Periodic Reporting for period 1 - PRESCRIP-TEC (Prevention and Screening Innovation Project Towards Elimination of Cervical Cancer)
Période du rapport: 2021-02-01 au 2022-07-31
The Prevention and Screening Innovation Project towards Elimination of Cervical Cancer (PRESCRIP-TEC), funded by the European Union under H2020, has started in February 2021. The project contributes to effective and innovative cervical cancer screening, including direct treatment and follow-up for women in resource-poor or hard-to-reach settings in the world. PRESCRIP-TEC will strengthen evidence of innovative strategies for cervical cancer screening as advocated by the World Health Organization and will contribute to eradication of cervical cancer worldwide through prevention and early diagnosis, alleviating the global burden of cancer.
PRESCRIP-TEC conducts implementation research into cervical cancer screening in four countries over three continents: Bangladesh and India in Asia, Uganda in Africa, and Slovakia in Eastern Europe. In this research universities, cancer institutes and non-governmental organisations from these countries collaborate with the University Medical Center in Groningen and the Female Cancer Foundation in the Netherlands.
We analyse patient- and health services-related facilitators and barriers for uptake of cervical cancer screening in low- and middle-income countries and in vulnerable groups in Eastern Europe. We will improve existing screening protocols in the four countries. We will introduce interactive information with communities via mobile devices and social media. We will initiate client-friendly, community-based strategies, with self-test for high risk HPV infection, and artificial intelligence decision support systems in gynaecological examination. The use of artificial intelligence built into mobile devices offers a future for high quality diagnostics in resource-poor settings. By combining self-test for hrHPV and artificial intelligence, we will reduce the number of physical examinations and enable screenings by lower-level trained cadres.
We perform a cost-effectiveness analysis and a produce a business case for the global introduction of hrHPV testing as routine screening for cervical cancer. We will show the advantage of point-of-delivery testing and the benefits of self-testing for cancer in the post-COVID era, which reduces pressure on the health system. This research, therefore will be a major contribution in supporting the global WHO strategy for elimination of cervical cancer.
PRESCRIP-TEC conducts implementation research into cervical cancer screening in four countries over three continents: Bangladesh and India in Asia, Uganda in Africa, and Slovakia in Eastern Europe. In this research universities, cancer institutes and non-governmental organisations from these countries collaborate with the University Medical Center in Groningen and the Female Cancer Foundation in the Netherlands.
We analyse patient- and health services-related facilitators and barriers for uptake of cervical cancer screening in low- and middle-income countries and in vulnerable groups in Eastern Europe. We will improve existing screening protocols in the four countries. We will introduce interactive information with communities via mobile devices and social media. We will initiate client-friendly, community-based strategies, with self-test for high risk HPV infection, and artificial intelligence decision support systems in gynaecological examination. The use of artificial intelligence built into mobile devices offers a future for high quality diagnostics in resource-poor settings. By combining self-test for hrHPV and artificial intelligence, we will reduce the number of physical examinations and enable screenings by lower-level trained cadres.
We perform a cost-effectiveness analysis and a produce a business case for the global introduction of hrHPV testing as routine screening for cervical cancer. We will show the advantage of point-of-delivery testing and the benefits of self-testing for cancer in the post-COVID era, which reduces pressure on the health system. This research, therefore will be a major contribution in supporting the global WHO strategy for elimination of cervical cancer.
In all four countries the geographical areas have been selected, where the screening programme will take place, as well as areas that will serve as control areas (where business as usual is continued).
Community sensitisation has started, by reaching out to local decision makers, health officials, local government organisations, as well as individual women and men through meetings, personal contacts, and social media.
A start has been made to offer women HPV self-testing at home, or in a health facility (if desirable), except for Slovakia, where the National Privacy Protection Agency required adjustments in the protocol. Testing is expected to start at the end of September/beginning of October 2022.
A start has been made with offering women who are HPV positive a follow-up VIA in Bangladesh, Uganda and India. A start has been made offering women cryotherapy or thermal ablation in Bangladesh, Uganda and India. So far, no women with invasive cancers have been diagnosed.
The AI software has been developed further for practical application in the field. Protocols have been developed for use of the software by the nurses who perform VIA with the decision support system. A device has been developed in India, based on a standard mobile phone, which ensures technical high quality and data protection. A “dry run” research has been carried out to measure the sensitivity and specificity of the AI device. Further “learning” of the algorithm is necessary. A start has been made with training staff and using the device in practice during the VIA screening in Uganda and Bangladesh.
An Electronic Medical Record has been developed based on the mHealth technology owned by Friendship in Bangladesh. Specific requirements for the data collection have been incorporated in the existing technology. The EMR is being used in Bangladesh and Uganda as primary data collection tool. Manually collected information is transferred into the mHealth in Slovakia and India, for later data analysis.
Clinical guidelines and protocols have been developed for the HPV self-testing, for the VIA performance, for the laboratory procedures for HPV testing, for the use of mHealth EMR, for the use of the AI- decision support system and for clinical research in general.
The personal factors of women eligible for cervical cancer screening and of decision-makers in the household (often husbands or mothers in law) in relation to cervical cancer have been measured by applying the AWACAN survey in the four countries. The client satisfaction survey for women using actual health services is in pre-testing. The service availability and readiness assessment (SARA) is in pre-testing. The methodology for measuring cost-effectiveness is under development, and basic data elements have been identified and data collection tools developed.
Community sensitisation has started, by reaching out to local decision makers, health officials, local government organisations, as well as individual women and men through meetings, personal contacts, and social media.
A start has been made to offer women HPV self-testing at home, or in a health facility (if desirable), except for Slovakia, where the National Privacy Protection Agency required adjustments in the protocol. Testing is expected to start at the end of September/beginning of October 2022.
A start has been made with offering women who are HPV positive a follow-up VIA in Bangladesh, Uganda and India. A start has been made offering women cryotherapy or thermal ablation in Bangladesh, Uganda and India. So far, no women with invasive cancers have been diagnosed.
The AI software has been developed further for practical application in the field. Protocols have been developed for use of the software by the nurses who perform VIA with the decision support system. A device has been developed in India, based on a standard mobile phone, which ensures technical high quality and data protection. A “dry run” research has been carried out to measure the sensitivity and specificity of the AI device. Further “learning” of the algorithm is necessary. A start has been made with training staff and using the device in practice during the VIA screening in Uganda and Bangladesh.
An Electronic Medical Record has been developed based on the mHealth technology owned by Friendship in Bangladesh. Specific requirements for the data collection have been incorporated in the existing technology. The EMR is being used in Bangladesh and Uganda as primary data collection tool. Manually collected information is transferred into the mHealth in Slovakia and India, for later data analysis.
Clinical guidelines and protocols have been developed for the HPV self-testing, for the VIA performance, for the laboratory procedures for HPV testing, for the use of mHealth EMR, for the use of the AI- decision support system and for clinical research in general.
The personal factors of women eligible for cervical cancer screening and of decision-makers in the household (often husbands or mothers in law) in relation to cervical cancer have been measured by applying the AWACAN survey in the four countries. The client satisfaction survey for women using actual health services is in pre-testing. The service availability and readiness assessment (SARA) is in pre-testing. The methodology for measuring cost-effectiveness is under development, and basic data elements have been identified and data collection tools developed.
The project is give evidence on the feasibility of the new WHO strategy for screening of cervical cancer, using hrHPV testing as basis for further action. The project will provide essential information on cost-effectiveness of the new screening protocol.
The project will test the use of artificial intelligence as decision-support system to enable task shifting in cervical cancer screening.
The project will test the use of artificial intelligence as decision-support system to enable task shifting in cervical cancer screening.