{"doi":"10.1200/go.21.00013","title":"Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening Among HIV-Positive Women in Western Kenya","abstract":"PURPOSE: Adjunct cervical cancer screening methods are under evaluation to improve the diagnostic accuracy of human papillomavirus (HPV)-based screening in low- and middle-income countries. 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 of 25-49 years of age enrolled in a clinical trial (ClinicalTrials.gov identifier: NCT04191967) had digital images of the cervix taken using a smartphone by a nonphysician provider following visual inspection with acetic acid. All participants had colposcopy-directed biopsy before treatment. Cervical images were evaluated by three off-site colposcopists for quality, diagnostic utility, and assigned a presumed diagnosis. We determined the proportion of images rates as low, medium, or high quality, interobserver agreement using Cohen's Kappa statistic, and the off-site colposcopist's sensitivity and specificity for diagnosis of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared with histopathology. Acceptability was evaluated using a questionnaire. RESULTS: One hundred sixty-four HPV-positive WLWH underwent cervicography during the study period. Mean age was 37.3 years. Images from the first 94 participants were evaluated by off-site colposcopists, with a majority (70.9%) rated as high quality. Off-site colposcopists had a sensitivity ranging from 21.4% (95% CI, 0.06 to 0.43) to 35.7% (95% CI, 0.26 to 0.46) and a specificity between 85.5% (95% CI, 0.81 to 0.90) to 94.9% (95% CI, 0.92 to 0.98) for diagnosis of CIN2+ based compared with histopathology. The majority of women, 99.4%, were comfortable having an image of their cervix taken as part of screening. CONCLUSION: Cervicography by a nonphysician provider as an adjunct to HPV-based screening among WLWH in a low- and middle-income country setting is feasible and acceptable. However, low sensitivity for diagnosis of CIN2+ by off-site expert colposcopists highlights the limitations of cervicography.","journal":"JCO Global Oncology","year":2021,"id":188403,"datarank":1.0016751957143826,"base_score":2.833213344056216,"endowment":2.833213344056216,"self_citation_contribution":0.42498200160843247,"citation_network_contribution":0.5766931941059501,"self_endowment_contribution":0.42498200160843247,"citer_contribution":0.5766931941059501,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":16,"citers_with_citation_signal":11,"citers_with_endowment":11,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9147,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT04191967"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":750283,"name":"Cirilus Ogollah Osongo","orcid":null,"position":1,"is_corresponding":false},{"id":750284,"name":"Jeniffer Ambaka","orcid":null,"position":2,"is_corresponding":false},{"id":749382,"name":"Magdalene Randa","orcid":"0000-0002-2319-6232","position":3,"is_corresponding":false},{"id":750285,"name":"Benard O. Samba","orcid":null,"position":4,"is_corresponding":false},{"id":750286,"name":"Catherine A. Ochieng","orcid":null,"position":5,"is_corresponding":false},{"id":749383,"name":"Emily Barker","orcid":"0000-0001-6682-0392","position":6,"is_corresponding":false},{"id":750287,"name":"Anagha Guliam","orcid":null,"position":7,"is_corresponding":false},{"id":750288,"name":"Jackton Omoto","orcid":null,"position":8,"is_corresponding":false},{"id":255293,"name":"Craig R. Cohen","orcid":"0000-0001-8654-6634","position":9,"is_corresponding":false},{"id":749381,"name":"Chemtai Mungo","orcid":"0000-0002-3655-4721","position":0,"is_corresponding":true}],"reference_count":36,"raw_metadata":null,"created_at":"2026-07-18T23:49:10.350554Z","pmid":"33999653","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}