Study protocol for a two-site clinical trial to validate a smartphone-based artificial intelligence classifier identifying cervical precancer and cancer in HPV-positive women in Cameroon

PLoS One. 2021 Dec 16;16(12):e0260776. doi: 10.1371/journal.pone.0260776. eCollection 2021.


Introduction: Cervical cancer remains a major public health challenge in low- and middle-income countries (LMICs) due to financial and logistical issues. WHO recommendation for cervical cancer screening in LMICs includes HPV testing as primary screening followed by visual inspection with acetic acid (VIA) and treatment. However, VIA is a subjective procedure dependent on the healthcare provider's experience. Its accuracy can be improved by computer-aided detection techniques. Our aim is to assess the performance of a smartphone-based Automated VIA Classifier (AVC) relying on Artificial Intelligence to discriminate precancerous and cancerous lesions from normal cervical tissue.

Methods: The AVC study will be nested in an ongoing cervical cancer screening program called "3T-study" (for Test, Triage and Treat), including HPV self-sampling followed by VIA triage and treatment if needed. After application of acetic acid on the cervix, precancerous and cancerous cells whiten more rapidly than non-cancerous ones and their whiteness persists stronger overtime. The AVC relies on this key feature to determine whether the cervix is suspect for precancer or cancer. In order to train and validate the AVC, 6000 women aged 30 to 49 years meeting the inclusion criteria will be recruited on a voluntary basis, with an estimated 100 CIN2+, calculated using a confidence level of 95% and an estimated sensitivity of 90% +/-7% precision on either side. Diagnostic test performance of AVC test and two current standard tests (VIA and cytology) used routinely for triage will be evaluated and compared. Histopathological examination will serve as reference standard. Participants' and providers' acceptability of the technology will also be assessed. The study protocol was registered under (number NCT04859530).

Expected results: The study will determine whether AVC test can be an effective method for cervical cancer screening in LMICs.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetic Acid / chemistry
  • Adult
  • Artificial Intelligence*
  • Cameroon / epidemiology
  • Clinical Trials as Topic
  • Early Detection of Cancer / methods*
  • Female
  • Humans
  • Middle Aged
  • Papillomaviridae / genetics
  • Papillomaviridae / isolation & purification*
  • Papillomavirus Infections / complications*
  • Papillomavirus Infections / virology
  • Prognosis
  • Prospective Studies
  • Smartphone / statistics & numerical data*
  • Uterine Cervical Dysplasia / diagnosis*
  • Uterine Cervical Dysplasia / epidemiology
  • Uterine Cervical Dysplasia / virology
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / virology


  • Acetic Acid

Associated data


Grants and funding

This research project will be supported by the University Hospitals of Geneva (Commission des Affaires Humanitaires (CAH), Solidarité Internationale Genève (, Dschang District Hospital and École Polytechnique Fédérale de Lausanne (EPFL). The funders will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.