Implementing Cervical Cancer Screening Among Women Living with HIV in Ghana (I-CERV-GH)
Project Lead(s)
Associate Professor
Project Background
Women living with HIV (WLWH) are 6 times more likely to develop cervical cancer, but despite their increased risk, cervical cancer screening for HIV-positive women in Ghana is not routine. Lack of access to screening contributes to high mortality rates, with Africa bearing 90% of global deaths. Ghana's incidence and mortality rates are significantly higher than those in the USA.
Cervical cancer is caused by the human papillomavirus (HPV), which is acquired through sexual contact. If the immune system does not get rid of the virus, it stays silent on the cervix until many years later, when it causes cancer in some people. One way to prevent cervical cancer is to get young girls vaccinated before they become sexually active. Currently, vaccines are available, but Ghana is yet to begin a nationwide vaccination program. For those over 30 years of age, the cancer can still be prevented with regular screening. Previously, screening required taking a sample from the cervix (PAP smear) and having a specialist doctor (Pathologist) examine the sample to determine if there were cells that could lead to cancer. Due to the human resources and other logistics required, women in less-endowed countries have been left behind in screening.
This project aims to determine how cervical cancer screening could be integrated into routine care for women living with HIV in Ghana, potentially allowing same-day testing and treatment. Screening will be done using the HPV polymerase chain reaction (PCR), which is now the recommended way to screen for early cervical cancer along with the GeneXpert machines. Nurses will also be trained to conduct screening, inspection, and early lesion treatment. The Cervical Cancer Prevention and Training Center at Battor has been training nurses for a while in the methods we want to use, and they are our partners in this project. The pilot will involve 6 clinics and hospitals, aiming to provide evidence for a national program and offering a framework for future initiatives.
The study sites are:
Greater Accra Region: Korle-Bu Teaching Hospital Infectious Diseases Center
Central Region: Ewim Polyclinic, Cape Coast Metropolitan Hospital and Elmina Polyclinic
Eastern Region: Atua Government Hospital and St. Martin de Porres Hospital, Agomanya
Overall, the study will benefit over 2000 women living with HIV in Ghana.
Objectives/Research Areas
Overall objective
To determine how cervical cancer screening could be integrated into routine care for women living with HIV in Ghana.
Specific objectives
- Determine the opportunities and barriers to integrating cervical cancer screening in the routine care of PLWH (People Living with HIV) in Ghana using the consolidated framework for implementation research (CFIR) and modified conjoint analysis.
- Determine the acceptability and reliability of self-sampling for HPV DNA testing among women living with HIV in Ghana using interviews and determination of concordance in HPV results between self- and provider-taken samples.
- Assess the feasibility of implementing same day “test, look and treat” for precancerous cervical cancer lesions in women living with HIV in Ghana.
Ongoing Activities
- Training of nurses at the Cervical Cancer Prevention and Training Center at Battor.
- Conducting of interviews for PLWH and Stakeholders.
Community Engagement Activities
Visit to Cervical Cancer Prevention and Training Centre (CCPTC), Battor, to interact with nurses on the I-CERV-GH project going through training.