A collaborative cervical precancer screening strategy with concurrent HPV genotyping and visual inspection using alumni of a training centre across Ghana: The Rotary 'Protect Your Pearl' initiative.

Abstract

Cervical cancer is a leading cause of cancer mortality among Ghanaian women, yet screening uptake is under 5%. The Cervical Cancer Prevention and Training Centre (CCPTC) partnered with Rotary Clubs across the country to implement the first-ever nationally representative cervical precancer screening project and to demonstrate the feasibility of an integrated nationwide screening program. We conducted a cross-sectional analysis of 1,636 asymptomatic women aged 25 years and above screened at 29 government and private facilities across all 16 regions of Ghana (January-February 2025). Eligible women underwent concurrent hr-HPV genotyping (Sansure MA-6000 platform) and VIA by CCPTC-trained alumni, with immediate thermal ablation for eligible VIA-positive lesions (TZ type 1 or 2). Multivariable logistic regression (backward stepwise elimination, P < 0.25 retention threshold) identified factors associated with hr-HPV positivity and VIA positivity. Analyses were performed in Stata v17.0. Among 1,636 women, the overall hr-HPV prevalence was 26·6% (95% CI, 24·5-28·8) and the VIA 'positivity' was 4·0% (95% CI, 3·1-5·0). Predominant genotypes were HPV52 (5·3%), HPV58 (4·4%), and HPV51 (3·6%); HPV16 and HPV18 together accounted for <5% of infections. Independent factors associated with hr-HPV infection were HIV infection (aOR=5·77; 95% CI, 2·07-16·13, P = 0.001) and having a steady partner (aOR=2·02; 95% CI, 1·22-3·36, P = 0.006); being married/cohabiting (aOR=0·51; 95% CI, 0·38-0·69, P < 0.001) or widowed (aOR=0·43; 95% CI, 0·23-0·82, P = 0.011), and prior screening (aOR=0·67; 95% CI, 0·48-0·92, P = 0.014) were protective. VIA 'positivity' was independently associated with HIV infection (aOR 7.49, 95% CI 1.99-28.19, P = 0.003). Regional hr-HPV prevalence varied from 10·0% to 39·2%. Thirty-five percent of VIA-positive women received same-visit thermal ablation. This decentralized alumni-driven model integrating off-site HPV testing, task-shifted VIA, and immediate thermal ablation proved operationally feasible across Ghana's diverse health system and revealed a substantial hr-HPV burden. The approach offers a scalable blueprint for national cervical cancer control and informs Ghana's transition toward HPV-based screening.