Expanding access to HPV screening through community health insurance schemes: lessons from a screening exercise for teachers in Ghana

Abstract

Cervical cancer (CC) screening uptake remains low primarily owing to the absence of organized screening and lack of insurance coverage. Members of the Ghana National Association of Teachers (GNAT) contribute monthly to an insurance scheme which covers cancer (including CC) treatment but not cervical precancer screening/treatment. We conducted this study to examine health beliefs shaping cervical screening uptake among educators and to understand how the scheme could scale cervical precancer screening and treatment services for beneficiaries across the country. From February − July 2022, we performed cervical precancer screening with concurrent hr-HPV DNA testing and visual inspection with acetic acid (VIA) for 102 teachers in 3 districts in the Volta Region. From April − May 2024, we conducted a cross-sectional study among 498 female subscribers of the GNAT insurance scheme in the same districts using non-probability snowball sampling. Data on utilization of cervical cancer screening services and risk factors were collected using a self-administered questionnaire. Health beliefs and situational factors associated with screening uptake among school teachers were assessed. Although all 498 female school teachers were enrolled in the cancer insurance scheme, cervical cancer screening uptake was reported by 116 (23.9%). Utilization of cervical cancer screening services was 25.3% among married women and 34.4% among women who reported limited access to screening. In the final adjusted logistic regression model, perceived barriers to screening (aOR, 0.55; 95% CI, 0.42 − 0.72) and being divorced/widowed (aOR, 2.11; 95% CI, 1.10–4.03 vs. married/cohabitating) were independently associated with cervical precancer screening uptake. The hr-HPV prevalence and VIA ‘positivity’ rate were 17.3% (95% CI, 9.9–24.8) and 1.0% (95% CI, 0.0–5.5), respectively. Cervical precancer screening utilization among female teachers enrolled in the GNAT cancer insurance scheme was sub-optimal owing to barriers related to low awareness, limited access, and social factors. The cancer insurance scheme represents a golden opportunity to overcome the identified barriers and improve HPV screening access and outcomes in addition to increasing access to cervical cancer treatment and should be explored.