My 150-hour experience is working on a Bass Connections team, specifically the Pocket Colposcope Project, which is focused on a compressive analysis of bringing elements of referral services to primary/community care. The Bass Connections Pocket Colposcope team is an extension of the Duke Center for Global Women’s Health Technologies. The Pocket Colposcope is a novel cervical cancer screening device that is low cost, portable, and makes the cervical cancer screening process painless. The project’s aim is to evaluate the barriers to the implementation of this device in low-income community health settings throughout rural Peru. Despite being a highly preventable cancer, cervical cancer still affects 500,000 women worldwide each year. The current care paradigm includes: 1) screening in a community care setting, 2) confirmatory diagnosis by colposcopy and biopsy in a referral setting and 3) treatment for screen-positive women in a facility equipped for such care. Up to 90% of women can be lost at each stage of the follow-up process, especially in medically underserved regions. Overall, this experience is incredibly innovative and exactly the type of work I want to pursue.
For this project, there are three main workstreams: the policy implications, clinical acceptability, and cost-effectiveness of bringing the device to community health providers in the Andean region of Peru. The policy workstream works to understand the political climate in Peru and the regulations relevant to our medical device. This workstream is also in charge of understanding the policy mechanisms and payment systems in place that might affect implementation, such as insurance codes that determine how providers get paid for services. The acceptability workstream focuses on stakeholder assessments to understand the less formal barriers to the device being accepted in Peru. Stakeholders include the doctors, midwives, nurses, community health workers, and other providers. The last workstream is cost-effectiveness, which aims to understand the economics of the Pocket in the Peruvian low-income context, including how providers are reimbursed and what to charge for the device so that it is a sustainable model. Throughout my two semesters on this team, I was focused on the costing workstream due to my background in economics and finance.
I chose this experience because it really epitomizes applying what I have studied in my Social Innovation & Policy pathway coursework to a real problem. First, this project relates to my Social Innovation class because the project has clear positive social goals and through this work our team has the potential to make a real impact on women’s health. In order to be successful, my team had to make sure we really understand the local context, which is a major lesson I learned in my Social Innovation class. To this end, my team works directly with Peruvian organizations and stakeholders to really understand the care continuum in low-income community health settings in the Andean region of Peru. Secondly, this project was very related to what I learned in my Technology Commercialization class. In fact, I first heard about the Pocket Colposcope through that class and wrote a paper analyzing the device. Because this project dealt with a novel medical device, I was able to apply a lot of what I learned in this class, particularly regarding patents and licensing, regulation, and stakeholder analysis. This experience relates to my overall Social Innovation & Policy pathway because it has been a great opportunity to work on the implementation of a real innovative product in low-income community settings. As is often the case with social innovation, the actual implementation of innovations is much more complex than it seems with unexpected barriers and consequences. This was a great opportunity to gain hands-on experience learning how to approach such complex problems and use human-centered design to construct appropriate solutions with the aim of positive social change.
One of my learning objectives for this project was to gain hands-on experience working in a small team to implement an innovative technology. Through this experience, I have come to better understand some common barriers to implementation and the nuances of technology acceptability. In some of my I&E coursework, I learned about common barriers that might need to be overcome to successfully commercialize a technological innovation, but this experience provides insight into the reality of such a process. For example, obtaining Digemid approval is much more complex of a process than the application first appeared, and is nuanced with different licensing, translating, and other approval requirements, as well as difficulties managing the project budget.
I spent my time on the team focused on the costing team. My team conducted a literature review on cervical cancer (CC) screening, HPV vaccination, and CC epidemiology to inform a cost-effectiveness analysis of the Pocket Colposcope in Peru. We found that in general, HPV vaccination has been shown to be cost-effective, but there are challenges to scale-up in LMICs. Additionally, although studies for other Latin American countries have shown that HPV followed by cryotherapy (for HPV+) is cost-effective, there is a shortage of CEA studies on see-and-treat models for Peru. Our cost-effectiveness analysis addresses gaps in research on community health worker (CHW)-based and see-and-treat interventions for cervical cancer in Peru. The graphic below illustrates our method for our literature review: Method
My artifact for this experience is the poster my team created for the annual Bass Connections showcase.