Effah Kofi, Allotey John, Tekpor Ethel, Wormenor Comfort Mawusi, Amuah Joseph Emmanuel, Antwi-Boasiako Ernest, Kotey Erasmus Nikoi, Kemawor Seyram, Gedzah Isaac, Frempong Helena Maame Ama, Danyo Stephen, Sesenu Edna, Atuguba Bernard Hayford, Essel Nana Owusu Mensah, Akakpo Patrick Kafui
Catholic Hospital, Battor, Via Sogakope, P. O. Box 2, Battor, Volta Region, Ghana.
Allotey and Associates, Lane 14, Alt Lane, Accra, Ghana.
Sci Rep. 2025 Jan 11;15(1):1744. doi: 10.1038/s41598-024-81274-5.
Cervical cancer continues to disproportionately burden women in sub-Saharan Africa, and is the commonest gynecological cancer in Ghana. The Cervical Cancer Prevention and Training Centre (CCPTC), Battor, Ghana spearheaded the Ghana arm of the mPharma 10,000 Women Initiative (mTTWI) between September 2021 and October 2022. The aim of this study was to examine the outcomes of nationwide concurrent screening using high-risk human papillomavirus (hr-HPV) DNA testing and visual inspection methods, as well as factors associated with the screening outcomes. We conducted a descriptive retrospective cross-sectional study to estimate the prevalence of hr-HPV infection (nationally and regionally) and cervical lesions among women screened by graduates of our training center in their own settings (spokes) with remote supervision and mentoring by CCPTC trainers (hub). We modeled factors associated with hr-HPV infection using nominal logistic regression. Among 5217 women screened (mean age, 40.1 years), the overall prevalence of hr-HPV infection and cervical lesions were 29.1% (95% confidence interval [CI] 27.9-30.3) and 3.7% (95% CI 3.2-4.2), respectively. The prevalence distribution varied widely among regions, with the highest recorded in the Oti Region (32.8%) and the lowest recorded in the Upper West (20.7%) and North-East (20.7%) regions. The most frequently detected HPV genotype was other hr-HPV type(s) only (non-HPV16, non-HPV18) (23.5%; 95% CI 22.3-24.7), followed by HPV16 only (1.5%; 95% CI 1.2-1.8), and mixed infection with HPV18 + other hr-HPV type(s) (1.2%; 95% CI 0.9-1.5). Factors found to be significantly associated with hr-HPV infection among women screened included age < 35 years, having a relationship status apart from married/cohabitation, nulliparity, and HIV positivity. Drawing from our implementation of this model within the mTTWI, we posit that while Ghana prepares for organized screening, coordinating opportunistic screening could enable a phased expansion of cervical precancer screening with the help of international and local partners. This approach, combined with concurrent testing (hr-HPV DNA testing and visual inspection), holds promise for mitigating loss to follow-up among women requiring additional evaluation and lesion management.
宫颈癌继续给撒哈拉以南非洲地区的女性带来不成比例的负担，并且是加纳最常见的妇科癌症。加纳巴托尔的宫颈癌预防与培训中心（CCPTC）在2021年9月至2022年10月期间牵头开展了mPharma万名女性倡议（mTTWI）的加纳分支。本研究的目的是检查使用高危型人乳头瘤病毒（hr-HPV）DNA检测和肉眼检查方法进行全国同步筛查的结果，以及与筛查结果相关的因素。我们进行了一项描述性回顾性横断面研究，以估计在我们培训中心的毕业生在其各自场所（辐条）进行筛查、并由CCPTC培训师（中心）进行远程监督和指导的女性中，hr-HPV感染（全国和地区层面）和宫颈病变的患病率。我们使用名义逻辑回归对与hr-HPV感染相关的因素进行建模。在接受筛查的5217名女性（平均年龄40.1岁）中，hr-HPV感染和宫颈病变的总体患病率分别为29.1%（95%置信区间[CI] 27.9 - 30.3）和3.7%（95% CI 3.2 - 4.2）。患病率分布在各地区之间差异很大，奥蒂地区记录的患病率最高（32.8%），上西部（20.7%）和东北部（20.7%）地区记录的患病率最低。最常检测到的HPV基因型是仅其他hr-HPV类型（非HPV16、非HPV18）（23.5%；95% CI 22.3 - 24.7），其次是仅HPV16（1.5%；95% CI 1.2 - 1.8），以及HPV18与其他hr-HPV类型的混合感染（1.2%；95% CI 0.9 - 1.5）。在接受筛查的女性中，发现与hr-HPV感染显著相关的因素包括年龄<35岁、婚姻状况为非已婚/同居、未生育以及HIV阳性。从我们在mTTWI中实施该模式的经验来看，我们认为在加纳为有组织的筛查做准备的同时，协调机会性筛查可以在国际和当地合作伙伴的帮助下分阶段扩大宫颈癌前病变筛查。这种方法，结合同步检测（hr-HPV DNA检测和肉眼检查），有望减少需要进一步评估和病变管理的女性的失访情况。
