Utilization and outcome estimates of cervical precancer screening and associated factors among female health workers in Ghana: implications for primary screening programs

Abstract

Toward attaining the WHO’s 90-70-90 targets for cervical cancer elimination, female health workers (FHWs) play a crucial role in educating women about the importance of regular cervical screening and HPV vaccination. This study primarily examined the prevalence of hr-HPV infection and cervical lesions among FHWs screened using a variety of approaches in a primary care context in Ghana. It further sought to model factors associated with hr-HPV infection as a screening outcome and prior screening as a proxy for screening utilization among the FHWs. This cross-sectional study evaluated 307 otherwise asymptomatic FHWs who underwent cervical screening between June 2019 and March 2023 in a primary care context− either at the clinic of the Cervical Cancer Prevention and Training Center (CCPTC), Battor, Ghana, or during any of its outreach activities (at satellite clinics). Screening approaches included standalone testing, concurrent testing, or tritesting. Factors associated with hr-HPV infection and screening utilization were modelled using nominal logistic regression. Three-hundred and seven FHWs [mean age, 33.1 (SD 7.0) years] were screened. Prevalence estimates of screening outcomes were 8.6% (95% CI, 5.7 − 12.3) for visual inspection ‘positivity’, 9.1% (95% CI, 0.2 − 41.3) for abnormal cytology (ASCUS), and 23.8% (95% CI, 19.0 − 29.3) for hr-HPV infection [stratified as 27.0% (95% CI, 19.8 − 35.1) using AmpFire and 20.3% (95% CI, 13.9 − 28.0) using MA-6000]. Factors associated with hr-HPV infection were age, parity (aOR, 1.42; 95% CI, 1.02 − 1.97), current contraceptive use (aOR, 5.86; 95% CI, 1.33 − 25.72), visual inspection ‘positivity’ (aOR, 2.89; 95% CI, 1.11 − 6.82), and past (aOR, 0.18; 95% CI, 0.06 − 0.51) or current (aOR, 0.05; 95% CI, 0.01 − 0.41) non-estrogen-containing contraceptive use. Factors associated with prior cervical screening were age and marital status. Our study suggests that cervical screening based on visual inspection strategies was relatively poorly utilized by FHWs. The cross-sectional prevalence of hr-HPV and precancerous lesions suggests that FHWs maintain a similar risk for hr-HPV infection and cervical cancer as the general population. Health authorities planning to implement primary HPV screening should explore ownership strategies to improve the participation of FHWs through community engagement initiatives.