04409nas a2200457 4500000000100000008004100001260004600042653001900088653001200107653001900119653001800138653002700156653002600183653001300209653001500222653001400237653002300251100001300274700001200287700001400299700001500313700001300328700001400341700001400355700001300369700001200382700001400394700001300408700001100421700001900432700001200451700001300463700001400476700002300490245018600513856010900699300001100808490000600819520311200825022001403937 2026 d c09/2026bPublic Library of Science (PLoS)10aCarbon Dioxide10aLesions10aAdverse events10aLeishmaniasis10aHealth care facilities10aclinical laboratories10aEthiopia10aLeishmania10aDiagnosis10atreatment outcomes1 aZewdu FT1 aAlemu K1 aLambert S1 aMisganaw B1 aAbebe ZB1 aShegaw EF1 aNigusse T1 aAyana GM1 aMolla E1 aPullan RL1 aPalmer J1 aPitt C1 aHailemichael Y1 aMarks M1 aGadisa E1 aWalker SL1 aHenao-Martínez AF00aDiagnosis of localized cutaneous leishmaniasis and treatment outcomes following carbon dioxide cryotherapy performed by health centre staff: A pilot implementation study in Ethiopia uhttps://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0006930&type=printable a1 - 140 v63 a In Ethiopia, the incidence of cutaneous leishmaniasis (CL) is estimated to range from 20, 000–30, 000 new cases due to Leishmania aethiopica . Children and young adults, in rural communities with limited access to health care are most affected. The current standard of care, pentavalent sodium stibogluconate is only administered in specialist centres, has limited effectiveness and is associated with severe adverse effects. Cryotherapy is recommended in national guidelines at the primary care level to treat uncomplicated CL, but is rarely available due to limited numbers of trained clinicians and lack of resources. We co-developed and evaluated a decentralised intervention, administered at a rural health centre, using carbon dioxide (CO 2 ) cryotherapy, which is available for the treatment of cervical dysplasia. A pragmatic clinical trial design was used, providing training at the health centre that combined theoretical instruction with direct patient assessment. Study clinicians recruited patients with suspected CL who had a slit-skin smear performed with confirmation by expert microscopists. The diagnostic accuracy of trained clinical and laboratory staff at a rural health centre were compared to experts. Individuals aged ≥12 years with parasitologically confirmed uncomplicated CL received CO 2 cryotherapy. Participants were followed until Day 90. Cure was defined as complete re-epithelialization of the index lesion. The study was registered in the Pan African Clinical Trials Registry with trial number PACTR202605616785682. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=41111 . We trained seven clinicians and laboratory professionals at Keteteya Health Centre. Of 331 individuals who attended the clinic with skin disease, 158 (47.7%) were clinically diagnosed by trained clinical staff with CL. Overall 123 (78%) had laboratory confirmed CL and of these 85 (53.8%) received CO 2 cryotherapy. By Day 90, 68 of 77 (88.3% (95% CI: 78.5–94.1%)) were cured. Adverse events were mild and transient, with no individual discontinuing treatment. Trained health centre clinical and laboratory staff were able to accurately diagnose CL. CO 2 cryotherapy was safe and efficacious when administered by trained staff. A training programme to facilitate CO 2 cryotherapy appears to be a feasible approach to decentralizing CL diagnosis and treatment to primary healthcare facilities in endemic areas of Ethiopia.  a2767-3375