Nurses were trained to screen and read results visually within a few minutes. Women with visible lesions were offered cryotherapy during the same visit, or were referred for histologic evaluation. Patients with invasive cervical cancer were referred for surgery or radiation.
If nurses are uncertain about a suspicious lesion, they take digital photos, upload them to a website, and await feedback from a physician who has been alerted via text message. Dr. Parham explained the telemedicine aspect: "As we expanded from 4 to 8 to 18 clinics, we just could not make it around physically to answer all the questions."
Shortcomings of the test include a potential for both false negatives (which can lead to undiagnosed disease) and false positives (which can lead to unnecessary medical intervention, costs, and undue anxiety), he said.
Because of a low level of awareness of cervical cancer in the poor communities, Dr. Parham and his associates developed a team of local women to promote cervical cancer screening. "We call them ‘peer educators.’ They are very effective."
A study limitation was a substantial loss to follow-up. To meet this challenge, they implemented a system in which young people in the community use cell phones to call women who miss appointments. "Our follow-up rates have moved from 20% to more than 80%. There is something about getting a phone call that these women really appreciate."
A national expansion is underway, Dr. Parham said. "The Zambian government has embraced our program. We’ve already started rolling out in rural areas. We would like to incorporate HPV DNA–based screening when it becomes available and cost effective."
Screening has also expanded beyond the national border. About a year and half ago, the program’s staff trained 61 health care practitioners from 10 African nations and the People’s Republic of China on how to use the Zambian model. "In Cameroon, they took our model, screened more than 8,000 women, and [have] already started an HPV screening program." To date, Dr. Parham said, cervical cancer screening has reached approximately 1,500 women in Botswana, 1,200 more in Nigeria, and 1,000 in Zimbabwe.
At the meeting, Dr. Parham was presented the Hugh R.K. Barber, M.D., Presidential Lecture Award for his work. Dr. Parham had no relevant disclosures.