Abstract #108  -  The use of mobile telemedicine for remote diagnosis in HIV infected patients in Botswana
Authors:   Presenting Author:   Dr Carrie Kovarik - University of Pennsylvania
Additional Authors:  Dr.  Carrie Kovarik, Dr.  Rahat Azfar, Dr. Gordana Cavric, Dr.  Zsofia Szep, Dr. Sarah Ratcliffe, Ms.  Rachel Gormley, Ms.  Jennifer  Weinberg, Dr.  Ann Steiner, Dr.  Robert Lee, Dr. Leslie Castelo-Soccio, Ms.  Kelly Quinley, Dr.  Doreen Ramogola-Masire,
Aim: We will present preliminary data on two studies that separately evaluate the use of mobile telemedicine for the diagnosis and/or triage of (1) cervical pre-cancer/cancerous lesions and (2) skin disease in HIV infected patients in Botswana. The primary aim of the first study is to evaluate the accuracy and safety of remote diagnosis and/or triage by physicians using photographic images of the cervix transmitted via a mobile telemedicine. We plan to accomplish this aim through a prospective case control study involving women presenting to the Princess Marina Hospital in Botswana for routine gynecological evaluation. The primary aim of the second study is to determine whether mobile teledermatology is a reliable method for diagnosing mucocutaneous conditions in adults with HIV infection in Botswana. We accomplish these aims through a cross sectional study involving HIV patients presenting with dermatology complaints to the Princess Marina Hospital and surrounding clinics.
Method / Issue: Telemedicine is the use of medical information exchanged between sites via electronic communications for the purpose of education and patient care. Throughout the developing world, inadequate access to physicians and subspecialty care are serious problems that telemedicine can help address. The new field of mobile telemedicine allows medical consultations to be submitted via mobile phone, enabling health care to reach rural areas of the developing world, where cell phone coverage extends beyond computer networks. Numerous studies have shown the accuracy of standard telemedicine (using a camera and internet connection) for the diagnosis of skin diseases and cervical cancer screening; however, the published data on mobile telemedicine is limited. Software specifically for remote diagnosis, called ClickDoc, has been developed using the Samsung Soul U900 phone, which comes equipped with a 5 Megapixel camera. The software and phone have been tested in both a proof of concept study in Egypt, as well as preliminarily testing demonstrating successful end to end transmission of diagnostic photos from Gaborone, Botswana, to the University of Pennsylvania, USA.
Results / Comments: The study decribed in the aims is ongoing and preliminary results will be presented. We hypothesize that there will be significant concordance in the diagnosis of both cervical and skin lesions in HIV patients, when comparing the diagnosis of the on-site clinician to the diagnosis of the clinician evaluating the photos through telemedicine. We base this hypothesis on a proof of concept study that has been completed in Egypt. In a series of 30 dermatologic patients, each evaluated using the Samsung Soul U900 phone and ClicDoc data collection, concordance in diagnosis between the onsite and remote specialists were achieved in 23 out of 30 cases. Reason for non-concordance was primarily that the history received by the off-site doctor was deemed insufficient.
Discussion: Women in sub-Saharan Africa often present with advanced cervical cancer, even though precancerous lesions are detectable via cervical screening techniques. This is the result of multiple factors, including lack of screening, lack of appropriate referral, as well as HIV-HPV (human papillomavirus) co-infection. In order to improve the availability of cervical cancer screening in Botswana, we propose the use of mobile teledermatology as an adjunct tool to visual screening techniques for cervical cancer. Skin diseases are also common in Botswana, and morbidity can be significant. HIV positive patients have an increased prevalence of skin disease, including several conditions which, if present, may affect HIV management. Often, these conditions are unique to or present more severely in HIV infected patients than in the non-immunosuppressed population. Because of the high prevalence of HIV in sub-Saharan Africa, patients are disproportionately affected by significant mucocutaneous disease. This problem is further compounded by the severe lack of dermatologists in the region. We propose the use of mobile teledermatology evaluation as a tool to help detect skin conditions in HIV patients in sub-Saharan Africa, as well as to facilitate increased access to dermatologic care for patients with limited access to specialist physicians.
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