Primary HPV testing using home-based self-collection of the HPV sample is a promising screening approach for settings with a high burden of cervical cancer. The efficacy of such an approach depends on a high participation rate and a seamless follow-up of at risk women. As part of the ETiCCS (Emerging Technologies in cervical Cancer Treatment) initiative (www.eticcs.org) we developed and implemented a digital data management system that allows close monitoring of the screening process from sample collection at home to laboratory testing and clinical management for a rural community in the Gondar region of Ethiopia.
A digital prototype was developed with unique user interfaces for the community health worker, clinic nurse, lab technician, gynecologist and pathologist.
Sampling information captured by the community health worker during a home visit are stored on tablets and regularly synchronized with a clinic-based tablet at the time of sample delivery. The clinic-based tablet serves as a multidirectional hub for clinic, lab and referral information through synchronization to a central server to which the laboratory and gynecologist are also connected via browser. Server data can be accessed and corrected with audit trail by authorized person. Multilevel security includes password protection for users and encryption of sensitive private data.
1000 women are being recruited in 2 rural communities in the Dabat district, Gondar, Ethiopia. Eligible women are visited in their home and invited to provide a self-sample for HPV testing, HPV-DNA positive women are invited to the local clinic for p16INK4a /Ki-67 testing. Samples are assayed in a central lab and women with abnormal findings are referred to the gynecologist for clinical management.
The built prototype greatly improves access and linkage to cervical cancer screening programs using home-based HPV self-sampling. The prototype is ideal for scale-up of an organized screening approach in rural settings.