Incidence rate was found to be 24% An estimated 20 % of all cancers in female are linked with cervical cancer (CC) which are usually diagnosed at advanced stage. Visual tests constitute a promising approach in low-resource settings and there is good evidence on their ability to reduce incidence of and mortality from cervical cancer Objective: Eensure effectiveness of thermo coagulation therapy piloting test for treatment of CC

Methodology 1. Study Areas: Two districts with high disadvantage (Tamang, Magar, etc) population selected for piloting. Kavre district has 93 health facilities with 580 aged 30-60 population. Similarly Sindhupalchowk has 78 health facilities with average 512 aged 30-60 women population. Description Kavre Dist Sindhu Dist 1) Health Facilities 93 78 2) Estimated 30-60 women population for screening 54000 40000 3) Average number of pop per facilities 580 512 4) Estimated days for the camp - 100 women - screen/treatment 6 5 5) Total days for camp (for one group) (including travel days 651 468 6) Total days for camp (for two group) 325.5 234 Research design: A cross sectional pilot study will be conducted in order to evaluate acceptability, efficacy, safety and adverse events. Based on findings scale up protocol will be developed for the scaling up the intervention. Research Participant: The research participants will be all women aged 30-60 years old of particular study areas. Sample size: Census of women aged 30-60 years old. Study Duration: 5 years (from 2019 – 2024) Inclusion: All women of aged 30 – 60 years devoid of their marital status. Exclusion: The program exclude below 30 years old women. The program will also exclude the women who already removed uterus. Training

One day orientation and planning meeting will be held for the health post incharges, palika coordinator and mayor and deputy mayor. After completion of program orientation, a planning meeting will be held to fix date for camp in the particular health post. The training will be led by Family Welfare Division and Lifeline Nepal technical staff. Pre-testing of data collection tools Two day training will be provided to data collectors on the data collection tools. A dumy camp will be organized in a particular health facility to pre-test tool. Organization of camp – A cervical cancer screening camp in each health facility will be organized inviting all 30-60 years women to attend camps. During the camps, background information, VA screening, diagnosis and treatment recorded in the TAB. Further more, photo before and after diagnose will taken. Data Analysis – Data will be analyzed using framework analysis approach covering acceptability, efficacy, safety and adverse effects. Furthermore health workers perception of device acceptances Ethical approval – This protocol will be submitted to the relevant Nepal Health Research Council. Written informed consent of all women 30 – 60 years of age will be obtained after the completion cervical cancer screening and treatment.

Approach for Coordination at different level HEAL Group will make every effort to synchronize and integrate all activities of the study. Responsibilities, command and internal control structures will be established to ensure that the resources are used most effectively and efficiently. HEAL Group will monitor the field level activity in each month throughout the project. To conduct the joint monitoring with Nepal Health Research Council and Family Welfare Division will be requested for assuring the quality of project activities. International Level University of Utah will be responsible to coordinate with International level and other potential donors. Central Level The Office Manager will be responsible to coordinate with Government at the central level and INGOs. The Project Manager will periodically call the meeting inviting Nepal Health Research Council and Family Welfare Division> Province Level Program Coordinator will be responsible in coordinating study related activities at the Provinces and Local Government. Prior to implement the study at the HFs and community level, they will hold preliminary inception meeting with concerned officials of Provinces. They will assist the Provinces to circulate letters to concerned HFs through local government (Palikas) on the study. Site Coordinator/Training Coordinator will also periodically update the Palikas and provinces on data collection regarding the acceptability study.

Ministry of Health and Population of Nepal, University of Utah, USA and HEAL Goup