Published in PLOS One on 2026-06-26, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Kofi Effah, Dorothy Letitia Ametefe, Joseph Emmanuel Amuah, Nana Owusu Mensah Essel, Maxwell Afetor, Annita Edinam Dugbazah, Emmanuel Deho, Seyram Kemawor, Stephen Danyo, Edna Sesenu, Georgina Tay, Yohane Teye Kitcher, Isaac Gedzah, Isaac Williams, Gifty Belinda Klutsey, Emmanuel Timmy Donkoh
Source: PLOS One • DOI 10.1371/journal.pone.0350573
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
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.
Introduction
Cervical cancer (CC) is a leading cause of cancer-related mortality among women worldwide, despite being largely preventable through effective human papillomavirus (HPV) vaccination and secondary prevention strategies [1]. In 2022, an estimated 348,000 women died from CC globally; approximately 90% of these deaths occurred in low- and middle-income countries (LMICs) where access to preventive services remains limited [1]. Ghana exemplifies the significant challenges faced by many LMICs in tackling CC, ranking as the second most frequent cancer among Ghanaian women overall and among those aged 15–44 years [2]. Recent estimates indicate an age-standardized incidence rate of approximately 27 per 100,000 women and a mortality rate of 17–18 per 100,000 women [3]. Compounding the high incidence, a large proportion of CC cases in Ghana (approximately 70%) are diagnosed at an advanced stage, contributing significantly to the high mortality rates [1]. The Ghana National Reproductive Health Policy and Standards recommends cervical cancer screening using Visual Inspection with Acetic acid (VIA) and Pap tests for women of reproductive age (25–45 years); however, no funded national HPV-based program exists, and coverage remains <5% [4].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Kofi Effah, Dorothy Letitia Ametefe, Joseph Emmanuel Amuah, Nana Owusu Mensah Essel, Maxwell Afetor, Annita Edinam Dugbazah, Emmanuel Deho, Seyram Kemawor, Stephen Danyo, Edna Sesenu, Georgina Tay, Yohane Teye Kitcher, Isaac Gedzah, Isaac Williams, Gifty Belinda Klutsey, Emmanuel Timmy Donkoh. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Genotype distribution of high-risk and potential high-risk HPV types among women in different screening and clinic settings in Ghana and Kenya
- Evidence brief: Cervical leukoplakia in Ghana: Unveiling diagnostic challenges and informing low-resource screening strategies
- Evidence brief: Human papillomavirus genotypes and factors associated with major cervical smear abnormalities in a sickle cell endemic area of Kisangani, Democratic Republic of the Congo
![Study flowchart showing screening techniques and primary screening outcome.A total of 13,861 women were screened. Of these, 12,847 underwent visual inspection (VIA or enhanced visual assessment [EVA]/mobile colposcopy) with leukoplakia assessment, while 1,014 were screened using non-visual methods (HPV DNA testing and/or cytology) without leukoplakia assessment. Overall leukoplakia prevalence was 0.9% (n = 120/13,861; 95% CI: 0.7–1.1). Prevalence was 0.2% (n = 23) among VIA-screened women and 3.7% (n = 97) among EVA-screened women.](https://healthsignalafrica.com/wp-content/uploads/2026/10/hs-pmc13557359-figure-1024x576.jpg)
