For years, Stelia Facki wanted to get screened for cervical cancer. But in her remote village of Chitundu in Malawi’s Machinga district, the nearest hospital offering the service was hours away—too far and too expensive for the 30-year-old mother to reach. She’d also heard rumors that discouraged her: people said screening was only for older women, that it wasn’t meant for someone her age.
Then in May 2024, a community health worker came to Chitundu carrying something new: HPV self-sampling kits. Under a tree, she gathered local women and explained how they could screen themselves for cervical cancer privately and safely, right in their own community.
Stelia decided to try.
She collected her sample and handed it to the health worker for testing. A week later, the health worker returned to Stelia’s home with the results. She had tested positive for HPV.
Stelia Facki, a HPV community based self-sampling beneficiary from Chidundu Village, Machinga District, Malawi.
The health worker sat with Stelia, explained what the results meant, and told her she needed to go to Namanja Health Centre for follow-up care. This time, Stelia didn’t hesitate.
At the center, medical staff screened her again using visual inspection with acetic acid. They found precancerous lesions—abnormal cells that, if left untreated, would likely develop into invasive cancer.
Stelia received treatment that same day.
“I had been waiting for this service for years,” she said afterward. “Now I know I did the right thing—there was no discomfort from the self-sampling to treatment.”
Within weeks, she had recovered and began telling other women in Chitundu about her experience. “People used to say screening was dangerous,” said Stelia. “Now I tell them it’s the best thing I ever did for myself.”
Her story might have ended very differently. Instead, it illustrates how a new model of cervical cancer screening—bringing testing directly to communities rather than expecting women to travel to distant facilities—is beginning to work across Africa. And the largest self-sampling study of its kind on the continent has just confirmed it. The findings are reshaping cervical cancer elimination efforts across Africa.
The evidence behind community-based HPV screening
Cervical cancer kills more than 300,000 women globally each year. The vast majority of those deaths occur in sub-Saharan Africa. Yet cervical cancer remains one of the most preventable cancers through vaccination, screening, and timely treatment.
The challenge is not the science. It’s reaching women in remote, resource-limited settings where health facilities are few and far between.
That’s why the recent findings from the Community-Based Self Sampling Study (CBSS) matter. The study— funded by Unitaid and conducted across Malawi, Nigeria, Rwanda, Zambia, and Zimbabwe by CHAI in partnership with ministries of health —screened more than 14,600 women and tested whether bringing screening into communities could work as well as facility-based care.
The answer was yes.
In most countries, women who tested positive for HPV after screening themselves in their communities were just as likely to return to a health facility for further screening and diagnosis as women who were initially tested at a health center. It didn’t matter whether women picked up self-sampling kits at community health posts, as Stelia did in Malawi, or received them through door-to-door visits by health workers, as they did in Rwanda. Both approaches worked.
The numbers tell the story: 21 percent of women tested HPV-positive. Ninety-four percent received their results. And 85 percent came back for further screening—often after just a single follow-up call or visit.
These findings confirm that community-based HPV self-sampling isn’t just feasible—it’s highly effective. It offers a practical pathway to expand cervical cancer screening in settings where women have little access to traditional facility-based testing.
Scaling community cervical cancer screening across Africa
Malawi’s Ministry of Health is now scaling up community-based HPV self-testing with support from Unitaid and CHAI. The goal is to bring screening closer to women like Stelia.
It’s part of a broader wave of progress taking shape across Africa. Countries are translating years of pilot programs and health system analysis into practical action toward cervical cancer elimination.
CHAI, with continued support from Unitaid, is entering a new phase of work to help Malawi, South Africa, Rwanda and other countries over the next two years. The focus: translate national plans into action, scale effective community-based service delivery models, and strengthen domestic financing.
The innovations that saved Stelia’s life—self-testing, same-day treatment, digital follow-up systems—will become standard components of women’s health services across the continent and further propel the global movement to make cervical cancer a disease of the past.
