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We previously developed a low-cost ablative therapy using ethanol mixed with ethyl cellulose (EC) to a form an ethanol-retaining gel that reduces injection leakage. To optimize delivery of EC-ethanol into the cervix, we developed and compared three speculum-compatible injectors that each address clinical challenges: 1) a single\u00a0needle injector, which contained an adjustable depth stop to control the depth of injection, 2) a multi\u00a0needle injector, which injected three locations in the cervix simultaneously, and 3) an extender injector, which included a needle extender.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>The variability in EC-ethanol injections was evaluated through bench top and <jats:italic>ex vivo<\/jats:italic> swine testing. Usability testing was performed by gynecology (GYN) providers who used each device in a custom pelvic model.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Both the extender and single\u00a0needle devices led to consistent ejection volumes in benchtop tests with no variability between injections. All devices achieved spherical depots with minimal leakage in <jats:italic>ex vivo<\/jats:italic> tests. In usability testing, 65% of GYN providers preferred the extender device, which achieved significantly shorter injection times in the custom pelvic model compared to other injectors.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>While all devices met clinical constraints, the extender device was preferred by clinicians and achieved repeatable injection distributions. This work presents a clinically informed low-cost intracervical delivery method for LMICs. Future work will include validating performance in clinical trials and assessing feasibility in clinical settings to advance global cervical neoplasia treatment.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10439-025-03799-8","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T16:36:52Z","timestamp":1753115812000},"page":"2658-2668","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Usability of Speculum-Compatible Injection Devices for Administering Ethyl Cellulose-Ethanol Ablation to Treat Cervical Neoplasia in Low- and Middle-Income Countries"],"prefix":"10.1007","volume":"53","author":[{"given":"Taya","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ven\u00e9","family":"Richardson-Powell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Garvey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkata","family":"Sarojasamhita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Aroom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martha O.","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Crouch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nimmi","family":"Ramanujam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Hurvitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5198-8491","authenticated-orcid":false,"given":"Jenna","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"issue":"2","key":"3799_CR1","doi-asserted-by":"publisher","first-page":"e197","DOI":"10.1016\/S2214-109X(22)00501-0","volume":"11","author":"D Singh","year":"2023","unstructured":"Singh, D., et al. 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Mueller, Crouch, and Ramanujam work with the Calla Health Foundation, from which they may benefit financially. The other authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The usability study was approved by the University of Maryland School of Medicine IRB panel (IRB: HP-00108639).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}