{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:48:40Z","timestamp":1791499720585,"version":"4.3.4"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T00:00:00Z","timestamp":1616457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2021,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Malawi has the highest invasive cervical cancer (ICC) mortality rate worldwide, and ICC is the leading cause of cancer death among women. In 2004, Malawi adopted visual inspection with acetic acid (VIA) and ablative treatment with cryotherapy. However, screening coverage has remained low (&lt;30%) and few women (&lt;50%) who require ablative treatment receive it. Additional barriers include long distances to health facilities and challenges with maintaining gas supplies. Thermal ablation is a safe and effective alternative to cryotherapy. We assessed the safety and uptake of community\u2010based ICC screening with VIA and same\u2010day treatment using a handheld thermocoagulator (HTU) in rural Malawi. We held educational talks alongside community leaders and conducted VIA screening in nonclinic community settings to nonpregnant women aged 25 to 49\u2009years without history of hysterectomy or genital cancer\/precancer. Eligible women received same\u2010day thermal ablation and HIV testing\/counseling. We collected cervical biopsies before treatment and followed up women at Weeks 6 and 12, with repeat biopsy at Week 12. Between July and August 2017, 408 (88%) of 463 eligible women underwent VIA. Overall, 7% (n\u00a0=\u00a030) of women had a positive VIA, of whom 93% (n\u00a0=\u00a028) underwent same\u2010day thermal ablation. Among the 30 VIA\u2010positive women, 5 had cervical intraepithelial neoplasia (CIN) 1, 4 had CIN 2\/3 and 21 had benign histologic findings. Abnormal vaginal discharge (60%) and light vaginal bleeding (52%) were the most reported adverse events. There was high uptake of the community\u2010based ICC screening in the study population and treatment was safe in this setting. Similar strategies that minimize false\u2010positive results are urgently needed in Malawi.<\/jats:p>","DOI":"10.1002\/ijc.33549","type":"journal-article","created":{"date-parts":[[2021,3,9]],"date-time":"2021-03-09T13:43:58Z","timestamp":1615297438000},"page":"371-377","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Uptake and safety of community\u2010based \u201cscreen\u2010and\u2010treat\u201d with thermal ablation preventive therapy for cervical cancer prevention in rural Lilongwe, Malawi"],"prefix":"10.1002","volume":"149","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3690-4207","authenticated-orcid":false,"given":"Lameck","family":"Chinula","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Global Women's Health University of North Carolina Project\u2010Malawi  Lilongwe Malawi"},{"name":"Department of Obstetrics and Gynecology University of North Carolina  Chapel Hill North Carolina USA"},{"name":"Department of Obstetrics and Gynecology University of Malawi, College of Medicine  Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary M.","family":"Topazian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Global Women's Health University of North Carolina Project\u2010Malawi  Lilongwe Malawi"},{"name":"Department of Epidemiology University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clement","family":"Mapanje","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Global Women's Health University of North Carolina Project\u2010Malawi  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Varela","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Global Women's Health University of North Carolina Project\u2010Malawi  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chapola","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Global Women's Health University of North Carolina Project\u2010Malawi  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9052-4956","authenticated-orcid":false,"given":"Laura","family":"Limarzi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Global Women's Health University of North Carolina Project\u2010Malawi  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Stanley","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Global Women's Health University of North Carolina Project\u2010Malawi  Lilongwe Malawi"},{"name":"School of Public Health Witwatersrand University  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Hosseinipour","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Global Women's Health University of North Carolina Project\u2010Malawi  Lilongwe Malawi"},{"name":"Department of Medicine University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satish","family":"Gopal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Global Women's Health University of North Carolina Project\u2010Malawi  Lilongwe Malawi"},{"name":"Department of Epidemiology University of North Carolina  Chapel Hill North Carolina USA"},{"name":"Department of Medicine University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer H.","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Global Women's Health University of North Carolina Project\u2010Malawi  Lilongwe Malawi"},{"name":"Department of Obstetrics and Gynecology University of North Carolina  Chapel Hill North Carolina USA"},{"name":"Department of Obstetrics and Gynecology University of Malawi, College of Medicine  Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70175-X"},{"key":"e_1_2_10_4_1","unstructured":"UNAIDSGlobal HIV & AIDS Statistics\u20142018 fact sheet UNAIDShttp:\/\/www.unaids.org\/en\/resources\/fact-sheetAccessed December 19 2018."},{"key":"e_1_2_10_5_1","unstructured":"National Statistical Office\u2014NSO\/Malawi and ICF.2017.Malawi Demographic and Health Survey 2015\u201016. 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