{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T14:15:53Z","timestamp":1768572953743,"version":"3.49.0"},"posted":{"date-parts":[[2025,10,28]]},"group-title":"Obstetrics and Gynecology","reference-count":35,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,12,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Innovative strategies are crucial to meet the World Health Organization\u2019s 90\/70\/90 cervical cancer elimination targets, and to prevent millions of deaths by 2030. Women in low-and-middle income countries (LMICs) bear the greatest burden of cervical cancer, yet have limited access to cervical precancer treatment. Scalable solutions like self-administered intravaginal therapies can help close this treatment gap. In an ongoing Phase 1 trial of intravaginal artesunate pessaries as primary treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN 2\/3), we evaluated the acceptability of this intervention among trial participants.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>17 participants completed in-depth interviews in their preferred language, focusing on their experiences with artesunate self-administration, including their interactions with the health system, partners, and community while on treatment. In the qualitative study, acceptability was defined as \u201csatisfaction with the product and willingness to use it in the future\u201d as well as \u201ccorrect and consistent use during the study.\u201d We conducted a thematic analysis using the socioecological framework.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Participants in this Phase 1 trial were primarily low-income women, with limited formal education, and the majority were also living with HIV and had been on antiretrovirals for over a decade. Despite minimal prior experience with vaginal self-administration of medication, participants found the pessary acceptable and were highly motivated to get treatment for cervical precancer. Social support, educational interventions, and faith were crucial in enabling participants to complete the treatment protocol successfully.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Kenyan women found self-administered intravaginal artesunate for treating CIN2\/3 to be highly acceptable. Randomized studies of intravaginal artesunate and other topical therapies in LMICs are needed to evaluate their use in closing the treatment gaps in these settings.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.10.24.25338731","type":"posted-content","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T23:15:16Z","timestamp":1761693316000},"source":"Crossref","is-referenced-by-count":0,"title":["\u201cWhen a thorn comes into your body, you must remove it.\u201d A Socio-Ecological analysis of the Acceptability of Intravaginal Artesunate as Cervical Precancer Treatment in a Phase 1 Clinical trial"],"prefix":"10.64898","author":[{"given":"Annum","family":"Sadana","sequence":"first","affiliation":[{"name":"New York University Grossman School of Medicine, New York, New York, United States"},{"name":"Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anagha","family":"Guliam","sequence":"additional","affiliation":[{"name":"Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Opiyo","sequence":"additional","affiliation":[{"name":"Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Adundo","sequence":"additional","affiliation":[{"name":"Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Sorgi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erum","family":"Agha","sequence":"additional","affiliation":[{"name":"School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chemtai","family":"Mungo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"},{"name":"Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"},{"name":"Center for AIDS Research, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026010105425782000_2025.10.24.25338731v3.1","unstructured":"Cervical Cancer Elimination Initiative. 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