Cross-sectional evaluation of a peer educator-led empowerment initiative for improving participation in cervical precancer screening among female sex workers in Ghana.

Abstract

Purpose: Despite having an increased risk of HPV infection, female commercial sex workers (FCSWs) have low uptake of cervical screening. Among FCSWs in the Volta Region of Ghana referred for screening following peer education, we examined the prevalence of high-risk human papillomavirus (hr-HPV) and cervical lesions and modelled factors associated with these screening outcomes.

Patients and methods: As part of the mPharma Ten Thousand Women Initiative, implemented between September and October 2022, 340 FCSWs in Ho and Aflao were recruited by peer educators. Screening involved MA-6000 testing (with full genotyping using the AmpFire HPV platform) and enhanced visual assessment (EVA) mobile colposcopy.

Results: The FCSWs screened had a mean age of 31.9 (SD, 9.3) years. The prevalence of cervical lesions on mobile colposcopy was 9.8% (95% confidence intervals (CI), 4.9-14.7), while the prevalence of hr-HPV infection among the FCSWs was estimated at 28.0% (95% CI, 20.6-35.3). The commonest individual genotype was HPV68 (9.1%; 95% CI, 4.9-15.0), while the least common genotypes were HPV33 and HPV39 (each 0.7%; 95% CI, 0.0-3.8). FCSWs screened in Aflao maintained threefold higher odds of hr-HPV infection (aOR, 3.33; 95% CI, 1.18-9.40) and having clinically significant EVA findings was associated with approximately fivefold higher odds of hr-HPV infection (aOR, 4.64; 95% CI, 1.09-19.83; p-value = 0.038). Condom use at the time of screening was independently associated with decreased odds of hr-HPV infection (aOR, 0.14; 95% CI, 0.04-0.49; p-value = 0.002). HIV infection (aOR, 9.95; 95% CI, 1.19-83.37) and engagement in oral-genital contact (aOR, 5.56; 95% CI, 1.35-22.94) were associated with higher odds of clinically significant EVA findings.

Conclusion: Our study underscores the urgent need for comprehensive and targeted interventions to reduce the burden of hr-HPV and the potential for cervical precancer/cancer among FCSWs in Ghana. We further highlight the importance of promoting continuous condom use among FCSWs during interactions with patrons and considering HIV status in the development and implementation of cervical precancer screening programs for FCSWs.