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. 2022 Sep;56(3):134-140.
doi: 10.4314/gmj.v56i3.2.

Application of the hub and spokes model in improving access to cervical cancer screening in Ghana

Kofi Effah  1 , Evans K Attivor  2 , Bernard H Atuguba  1 , Donatus D Adaletey  1 , Delali A Ofori  2 , Philip Diame  1 , Ethel Tekpor  1 , Comfort M Wormenor  1 , Isaac Gedzah  1 , Dominic Agyiri  1 , Joseph E Amuah  1 , Patrick K Akakpo  3 , Jonathan M Gmanyami  4 , Martin Adjuik  4 , Hubert Amu  4 , Margaret Kweku  4
Affiliations

Application of the hub and spokes model in improving access to cervical cancer screening in Ghana

Kofi Effah et al. Ghana Med J. 2022 Sep.

Abstract

Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District.

Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing.

Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes.

Main outcome measure: The detection of screen positives.

Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes.

Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed.

Funding: None declared.

Keywords: Cervical Cancer; Ghana; North Tongu District; hub and spokes model; low resource settings; prevention; screening.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 2
Figure 2
Map of North Tongu District showing the hub (red star) and the spokes (green stars)
Figure 3
Figure 3
Hub and Spokes Model developed for North Tongu District
Figure 4a
Figure 4a
Screening method used by the Hub
Figure 4b
Figure 4b
Screening method used by the spokes
Figure 5
Figure 5
Screen positives among women screened in the hub and spokes
Figure 6
Figure 6
Radical hysterectomy specimen for a woman with early cervical cancer.
Figure 7
Figure 7
Twenty-five (25) year- old with a lesion (leukoplakia) picked up at one of the spokes. A- after application of acetic acid (spokes); B - after application of Lugol's iodine (spokes); C. LEEP specimen, stitch at 12 o'clock (hub); D. Cervix after LEEP (hub
Figure 1
Figure 1
Map of Ghana showing the location of the North Tongu District (Black Star)
See this image and copyright information in PMC

References

    1. ICO/IARC Information Centre on HPV and Cancer. 2021.
    1. Fang-Hui Z, Adam K L, Feng C, Lin M J, ShangYing H, et al. Pooled Analysis of a Self-Sampling HPV DNA Test as a Cervical Cancer Primary Screening Method. J Natl Cancer Inst. 2012;104:178–188. - PMC - PubMed
    1. Ghana; Human Papillomavirus and Related Cancers, Fact Sheet. 2017. [22nd July 2018]. 2017-07-27 document available at: www.hpvcentre.net/statistics/reports/GHA_FS.pdf.
    1. Nartey Y, Hill P, Amo-Antwi K, et al. Recommendations for cervical cancer prevention and control in Ghana: public education and human papillomavirus vaccination. Ghana Med J. 2018;52(2):94–102. doi: 10.4314/gmj.v52i2.6. - DOI - PMC - PubMed
    1. Tsu V, Jerónimo J. Saving the World's Women from Cervical Cancer. N Engl J Med. 2016;374:2509–2511. doi: 10.1056/NEJMp1604113. - DOI - PubMed