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Abdi M, Tamiru A, Tilahun T, Tiruneh G, Fite MB. Factors associated with human papillomavirus infections among women living with HIV in public health facilities in Western Oromia, Ethiopia. BMC Womens Health 2024; 24:423. [PMID: 39054526 PMCID: PMC11270813 DOI: 10.1186/s12905-024-03249-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Human Papillomavirus infection (HPV) is among the most common sexually transmitted infections with the highest incidence and prevalence worldwide. HPV has been established as the main cause of cervical cancer and remains a public health problem globally. In Western Oromia, Ethiopia cervical screening remains a major issue because of limited resources, and shortage of HPV testing technology. As a result, the prevalence of HPV and associated factors remain unknown among HIV-positive women. This study aimed to assess the prevalence of HPV and associated factors among women living with HIV attending Antiretroviral Therapy (ART) services in public health facilities of East Wollega and West Showa Zones, Ethiopia, 2022. METHOD Using a cross-sectional study design, a total of 415 women ≥ 18 years old were enrolled using systematic random sampling from five public health facilities. Cervical specimens were collected by a trained nurse from April 01 2022, to May 30, 2022, and tested at Nekemte Public Health Research and Referral Molecular Biology, a certified/accredited laboratory for HPV-DNA Polymerase Chain Reaction by expertise using Abbott m2000rt-PCR assays. Finally, Epi data version 4.6 was used for data entry and SPSS version 24.0 were used for data cleaning and analysis, and frequencies and prevalence of HPV were computed. Variables were identified using the multivariable model and statistically significant associations of variables were determined based on the adjusted odds ratio (AOR) with its 95% CI and P-value < 0.05 to determine the strength of association. RESULT The prevalence of HPV was 30.4% [95% CI: 26.0, 34.9]. Of HPV-infected women, 11.9% were positive for HPV-16, 9.5% for HPV-18, and 65.9% were positive for other hr-HPV . The odds of HPV infection among women aged beyond 48 years are 2.85 times the odds of HPV among people who were aged 18-27(AOR = 2.85, 95% CI: 1.16, 5.58). The odds of HPV infection among women who had three or more sexual partners is 4.12 times the odds of HPV infection among women with a single sexual partner(AOR = 4.12, 95% CI: 2.34-8.62). The odds of HPV infection among women who didn't use condom during sexual intercourse are 4.73 times the odds of HPV among women who used condom during sexual intercourse. (AOR = 4.73, 95% CI: 1.98-9.33). The odds of HPV infection among women who had history of is 4.52 times the odds of HPV infection among women with no history of abortion. [AOR = 4.52, 95% CI: 2.04, 6.89] The odds of HPV infection among women with history of Sexually Transmitted Infection (STI) 3.62 times the odds of HPV among women with no history of STI (AOR = 3.62, 95%CI: 1.75, 5.83). The odd of HPV among women with abnormal vaginal discharge is 3.31 times the odds of the disease among women with normal vaginal discharge [AOR = 3.31, 95% CI: 2.87,7.35). CONCLUSION AND RECOMMENDATION The prevalence of HPV infection among HIV-infected women was high in the study area. Given the above-associated factors, we recommend that the stakeholders integrate HPV prevention strategies into HIV /AIDS services. Furthermore, the study has provided essential information about the HIV link with hr-HPV infections, which may explain the high prevalence among HIV-infected women. This can contribute to policy development and planning of prevention strategies incorporating HPV infection prevention especially among youth and HIV-infected people.
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Affiliation(s)
- Mulatu Abdi
- Nekemte public health research and referral laboratory, Oromia regional health bureau, Nekemte, Ethiopia
| | - Afework Tamiru
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Temesgen Tilahun
- School of medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Gemechu Tiruneh
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Meseret Belete Fite
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- Department of Public, Sunshine College, Nekemte, Ethiopia.
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Traore B, Kassogue Y, Diakite B, Diarra F, Cisse K, Kassogue O, Diarra M, Coulibaly A, Coulibaly B, Diallo H, Diarra Z, Ly M, Maiga A, Sissoko SB, Sissoko AS, Traore CB, Kamate B, Teguete I, Bah S, Dolo G, Gursel DB, Holl J, Hou L, Maiga M. Prevalence of high-risk human papillomavirus genotypes in outpatient Malian women living with HIV: a pilot study. BMC Infect Dis 2024; 24:513. [PMID: 38778266 PMCID: PMC11110247 DOI: 10.1186/s12879-024-09412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Long-term exposure to high-risk human papillomavirus (Hr-HPV) is a well-known necessary condition for development of cervical cancer. The aim of this study is to screen for Hr-HPV using vaginal self-sampling, which is a more effective approach to improve women's adherence and increase screening rates. METHODS This pilot study included a total of 100 Women living with HIV (WLWHIV), recruited from the Center for Listening, Care, Animation, and Counseling of People Living with HIV in Bamako. Hr-HPV genotyping was performed on Self-collected samples using the Cepheid GeneXpert instrument. RESULTS The median age of WLWHIV was 44 (interquartile range [IQR], 37-50) years. Approximately 92% of the study participants preferred self-sampling at the clinic, and 90% opted to receive result notifications via mobile phone contact. The overall prevalence of Hr-HPV among study participants was 42.6%, and the most frequent Hr-HPV sub-types observed were HPV18/45 (19.1%), HPV31/35/33/52/58 (13.8%), and HPV39/68/56/66 (12.8%), followed by HPV16 (5.3%), and HPV51/59 (5.3%). WLWHIV under 35 years of age had a higher frequency of Hr-HPV compared to their older counterparts, with rates of 30% versus 11.1% (p = 0.03). The duration of antiretroviral treatment showed an inverse association with Hr-HPV negativity, with patients on treatment for 15 (IQR, 10-18) years versus 12 (IQR = 7-14) years for Hr-HPV positive patients (95% CI [1.2-5.8], t = 3.04, p = 0.003). WLWHIV with baseline CD4 T-Cell counts below 200 exhibited a higher frequency of Hr-HPV compared to those with baseline CD4 T-Cell counts above 200 (17.9% versus 1.9%, p = 0.009). However, other demographics and clinical factors, such as marital status, age of sexual debut, parity, education, history of abortion, history of preeclampsia, and cesarean delivery, did not influence the distribution of Hr-HPV genotypes. CONCLUSION Our findings indicate that WLWHIV under the age of 35 years old exhibited the highest prevalence of Hr-HPV infection, with HPV18/45 being the most prevalent subtype. Additionally, WLWHIV with baseline CD4 T-Cell counts below 200 showed the highest infection rates.
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Affiliation(s)
- Ban Traore
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Sciences and Techniques, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Yaya Kassogue
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali.
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
| | - Brehima Diakite
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Fousseyni Diarra
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Kadidiatou Cisse
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Oumar Kassogue
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Modibo Diarra
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Aissata Coulibaly
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Bourama Coulibaly
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hama Diallo
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Zoumana Diarra
- Center of Listening, Care, Animation, and Counseling for People Living With HIV, Bamako, Mali
| | - Madani Ly
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
| | - Aminata Maiga
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sidi Boula Sissoko
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Adama Seydou Sissoko
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Cheick Bougadari Traore
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bakarou Kamate
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ibrahima Teguete
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekou Bah
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Guimogo Dolo
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Demirkan Besim Gursel
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane Holl
- Department of Neurology, University of Chicago, Chicago, IL, 60637, USA
| | - Lifang Hou
- Institute for Global Health, Northwestern University, Chicago, IL, 60611, USA
- Preventive Medicine Department, Northwestern University, Chicago, IL, 60611, USA
| | - Mamoudou Maiga
- Centre of Research and Training on Molecular Pathologies, University Hospital of Point G, Bamako, Mali
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- Preventive Medicine Department, Northwestern University, Chicago, IL, 60611, USA
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Dreyer G, Visser C, Dreyer GJ, Botha MH, van der Merwe FH, Richter KL, Snyman LC. The performance of single and combination test strategies using visual inspection, cytology, high-risk HPV DNA and HPV16/18 to screen South African women with and without HIV-infection. Infect Agent Cancer 2024; 19:22. [PMID: 38725062 PMCID: PMC11084067 DOI: 10.1186/s13027-024-00586-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Cervical cancer screening strategies should ideally be informed by population-specific data. Strategies recommended for secondary prevention, are often inadequately studied in populations with high cervical disease burdens. This report describes the test performance measured against CIN2 + /CIN3 + histology in HIV-positive women (HPW) and HIV-negative women (HNW) with the aim to determine the most effective strategies to identify South African women at risk. METHODS Primary screening using visual inspection, cytology and HPV DNA (cobas®) was performed in two South African provinces on 456 HPW and 639 HNW participating in the multicentric DiaVACCS trial. Histology was obtained for 91.7% screen-positive and 42.7% screen-negative participants, and unavailable histology was determined by multiple imputation to adjust for verification bias. Cross-sectional test performance was calculated for single and combination test strategies with and without intermediate risk categories using different cut-offs. Minimum acceptability for sensitivity and specificity, treatment and follow-up numbers were considered to evaluate strategies. RESULTS The only single test to reach acceptability in HPW was cytology (LSIL) [sensitivity 71.2%; specificity 90.5%; treatment 33.4%]; in HNW only HPV (hr) qualified [sensitivity 68.2%; specificity 85.2%; treatment 23.5%]. The universally best performing strategy which also resulted in smaller treatment numbers without intermediate risk group was primary HPV(hr), with treatment of both HPV(16/18) and cytology (ASCUS +) [HPW: sensitivity 73.6%; specificity 89.7%; treatment 34.7%. HNW: sensitivity 59.1%; specificity 93.6%; treatment 13.9%]. DNA testing for hrHPV (any) and hrHPV (16/18) was the best universally acceptable strategy with an intermediate risk category (early follow-up) in HPW [sensitivity 82.1%; specificity 96.4%; treatment 17.1%; follow-up 31.4%] and HNW [sensitivity 68.2%; specificity 96.7%; treatment 7.6%; follow-up 15.9%]. In comparison, using both HPV (16/18) and cytology (ASCUS +) as secondary tests in hrHPV positive women, decreased follow-up [HPW 13.8%, HNW 9.6%], but increased treatment [HPW 34.7%, HNW 13.9%]. CONCLUSION Using hrHPV (any) as primary and both HPV16/18 and cytology as secondary tests, was universally acceptable without an intermediate risk group. Strategies with follow-up groups improved screening performance with smaller treatment numbers, but with effective management of the intermediate risk group as prerequisite.
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Affiliation(s)
- Greta Dreyer
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Cathy Visser
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Gerrit Jan Dreyer
- Department of Statistics and Actuarial Science, Faculty of Economic and Management Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Matthys H Botha
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Frederick H van der Merwe
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Karin L Richter
- Department Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Leon C Snyman
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Asare M, Obiri-Yeboah D, Enyan NIE, Nuer-Allornuvor G, Fosu ES, Ken-Amoah S, Akakpo PK. An intervention to increase cervical cancer screening among women living with HIV: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2024; 118:107993. [PMID: 37844427 DOI: 10.1016/j.pec.2023.107993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/01/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE We examined the effectiveness of a behavioral intervention in promoting cervical cancer screening among women living with HIV (WLWH) in Ghana. METHODS A Mixed-methods study was conducted involving 83 WLWH, who were randomly assigned to an intervention group (n = 42) to receive voice-recorded messages based on the 3 R model (Reframing, Reprioritizing, and Reforming) or a control group (n = 41) to receive standard care. The primary outcomes were screening uptake and HPV prevalence. Other outcomes were the acceptability, appropriateness, and feasibility of the intervention. RESULTS The intervention group had a 100% screening rate, and the control group had a 14.63% screening rate. The prevalent rate of high-risk (hr)-HPV genotypes among the women was 67.5% (95%C.I: 0.56-0.77). Over 48% of the participants had multiple hr-HPV genotypes, 64.29% had HPV16/18/45%, and 73.21% had HPV 31/33/45/52/58. Of the women (89.30%) who screened positive, 60% of them were diagnosed and treated for pre-cancer lesions. The intervention messages were acceptable (encourage proactive behavior), feasible (simple, easy to understand), and appropriate (helpful, informative). Facilitators and barriers to self-sampling were identified. CONCLUSION Combining the 3 R model with self-sampling increases cervical cancer screening among WLWH. PRACTICE IMPLICATION Healthcare professionals and policymakers can use this model to increase cervical cancer screening.
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Affiliation(s)
- Matthew Asare
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, PO Box 1 Bear Place, Waco, TX, USA
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, PO Box University Post Office, Cape Coast, Ghana
| | - Nancy Innocentia Ebu Enyan
- Department of Adult Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, PO Box University Post Office, Cape Coast, Ghana
| | - Gloria Nuer-Allornuvor
- Department of Obstetrics and Gynecology, Cape Coast Teaching Hospital, PO Box ct 1363, Cape Coast, Ghana
| | - Emmanuel Sarfo Fosu
- Department of Statistical Science, College of Arts & Sciences, Baylor University, PO Box 1 Bear Place, Waco, TX 76798, USA
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynecology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, PO Box University Post Office, Cape Coast, Ghana.
| | - Patrick Kafui Akakpo
- Department of Pathology, School of Medical Sciences, University of Cape Coast, PO Box University Post Office, Cape Coast, Ghana
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Sineque A, Catalao C, Ceffa S, Fonseca AM, Parruque F, Guidotti G, Massango C, Carrilho C, Bicho C, Rangeiro R, Orlando S, Marazzi MC, Lorenzoni C, Ciccacci F. Screening approaches for cervical cancer in Mozambique in HIV positive and negative women. Eur J Cancer Prev 2023; 32:431-437. [PMID: 37144587 DOI: 10.1097/cej.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Cervical cancer (CC) is a global health issue, in Mozambique, 5300 new cases and 3800 deaths are reported each year. The WHO recommends the introduction of HPV molecular testing for CC screening, but Mozambique uses an approach based on visual inspection with acetic acid (VIA). This study aims to evaluate the feasibility of high-risk HPV (hrHPV) testing compared to actual approaches in Mozambique. METHODS An observational study was carried out in the DREAM center in Zimpeto, Mozambique. Women aged 30-55 were included. HPV testing was performed with the Cobas HPV test. They were then screened with the current national recommendations based on VIA. Cryotherapy was performed on-site or referred for colposcopy if necessary. RESULTS In the period, 1207 women were enrolled, 47.8% HIV+; 124 (10.3%) VIA+, and HPV DNA test was positive in 325 (26.9%) women. HPV positivity rates were higher in HIV-infected women. In the sample, 52.8% of the 124 VIA+ women were HPV uninfected and underwent unnecessary cryotherapy or colposcopy. Meanwhile, 24.7% of the 1083 VIA- women were actually HPV infected. In comparison, a screen, triage and treat approach based on hrHPV testing would only test and treat the 325 HPV-infected women. CONCLUSION The study found high rates of hrHPV infection, particularly in HIV-positive women, with many concurrent or multiple infections. The current screening method misses important hrHPV infections and results in many unnecessary treatments. These results support the use of HPV molecular testing as the initial screening test for CC.
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Affiliation(s)
- Alberto Sineque
- DREAM Program, Community of Sant'Egidio
- Department of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Susanna Ceffa
- DREAM Program, Community of Sant'Egidio, Rome, Italy
| | | | | | | | | | - Carla Carrilho
- Maputo Central Hospital
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Clara Bicho
- Institute for Preventive Medicine and Public Health, Institute of Environmental Health (ISAMB), Faculty of Medicine, University of Lisboa, Portugal
| | | | - Stefano Orlando
- Department of Biomedicine and Prevention, Torvergata University of Rome
| | | | | | - Fausto Ciccacci
- Unicamillus Saint Camillus International University of Health and Medical Sciences, Rome, Italy
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Sun L, Li L, Xu W, Ma C. The Immunomodulation Role of Vaginal Microenvironment On Human Papillomavirus Infection. Galen Med J 2023; 12:1-7. [PMID: 38827643 PMCID: PMC11144026 DOI: 10.31661/gmj.v12i0.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Evidence suggests the role of the vaginal microbiome and microenvironment in the immunity state. The human papillomavirus (HPV) infection is widely dependent on the healthy vaginal microenvironment. Hence, this study aimed to investigate the role of the vaginal microenvironment in the rate of high-risk HPV (hr-HPV) infection. MATERIALS AND METHODS This cross-sectional study was performed on 512 women with hr-HPV positive (n=212) or negative (n=300) infection. The vaginal samples of women were examined regarding yeas and Gardnerella vaginalis infection. Also, Lactobacillus acidophilus, pH, and enzyme activity (such as catalase, proline aminopeptidase, and leucocyte esterase) were compared between the two groups. Also, the histopathological study was performed on the vaginal samples. RESULTS The higher rate of yeast and G. vaginalis infections as well as decreased L. acidophilus, were significantly observed in women with hr-HPV positive infection (P0.001). Also, histopathological findings indicated that cervical intraepithelial neoplasia grade I-III and cervical cancer lesions were markedly higher in hr-HPV positive group compared with control women. CONCLUSION The hr-HPV infection was markedly correlated to vaginal microenvironments, and it could a risk factor for the elevation of the rate of high-grade cervical lesions.
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Affiliation(s)
- Lingyan Sun
- Department of Obstetrics and Gynecology Laboratory, The First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu 215000, China
| | - Li Li
- Department of Obstetrics and Gynecology Laboratory, The First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu 215000, China
| | - Wenxin Xu
- Department of Obstetrics and Gynecology Laboratory, The First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu 215000, China
| | - Cen Ma
- Department of Obstetrics and Gynecology Laboratory, The First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu 215000, China
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Nang DW, Tukirinawe H, Okello M, Tayebwa B, Theophilus P, Sikakulya FK, Fajardo Y, Afodun AM, Kajabwangu R. Prevalence of high-risk human papillomavirus infection and associated factors among women of reproductive age attending a rural teaching hospital in western Uganda. BMC Womens Health 2023; 23:209. [PMID: 37118735 PMCID: PMC10148521 DOI: 10.1186/s12905-023-02342-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/10/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND High-risk HPV is considered a major risk factor for the development of cervical cancer, the most common malignancy among women in Uganda. However, there is a paucity of updated epidemiological data on the extent of the burden and factors associated with hr-HPV infection among women of reproductive age. The aim of this study was to determine the prevalence and genotype distribution of hr-HPV and associated factors among women of reproductive age attending a rural teaching hospital in western Uganda. METHODS We conducted a cross-sectional study from April to June 2022. A total of 216 women of reproductive age attending the gynecological outpatient clinic were consecutively enrolled. Interviewer-administered questionnaires were used to collect participant characteristics, cervical specimens were collected by clinicians, and molecular HPV testing was performed using the Cepheid Xpert HPV DNA test. Descriptive statistics followed by binary logistic regression were conducted using SPSS version 22. RESULTS The prevalence of hr-HPV was 16.67%. Other hr-HPV types other than HPV 16 and 18 were predominant, with a prevalence of 10.6%; HPV 18/45 (2.31%), HPV 16 (0.46%), and 3.24% of the study participants had more than one hr-HPV genotype. On multivariate logistic regression, an HIV-positive status (aOR = 7.06, CI: 2.77-10.65, p = 0.007), having 3 or more sexual partners in life (aOR = 15.67, CI: 3.77-26.14, p = 0.008) and having an ongoing abnormal vaginal discharge (aOR = 5.37, CI: 2.51-11.49, p = 0.002) were found to be independently associated with hr-HPV infection. CONCLUSIONS AND RECOMMENDATIONS The magnitude of hr-HPV is still high compared to the global prevalence. HIV-positive women and those in multiple sexual relationships should be prioritized in cervical cancer screening programs. The presence of abnormal vaginal discharge in gynecology clinics should prompt HPV testing.
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Affiliation(s)
- David Wol Nang
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda.
| | - Happy Tukirinawe
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Maxwell Okello
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Bekson Tayebwa
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Pius Theophilus
- Department of Medical Laboratory Science, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Franck Katembo Sikakulya
- Department of Surgery, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Adam Moyosore Afodun
- Department of Anatomy and Cell Biology, Faculty of Health Sciences, Busitema University, Tororo, Uganda
| | - Rogers Kajabwangu
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
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Megersa T, Dango S, Kumsa K, Lemma K, Lencha B. Prevalence of high-risk human papillomavirus infections and associated factors among women living with HIV in Shashemene town public health facilities, Southern Ethiopia. BMC Womens Health 2023; 23:125. [PMID: 36959649 PMCID: PMC10036163 DOI: 10.1186/s12905-023-02279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/14/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Every year, large number of women are suffering from cervical cancer. Particularly women living with HIV are at high-risk of being suffered with it. Early testing of high-risk human papillomavirus infection can significantly reduce the incidence of cervical cancer. However, lack of early and regular testing has been identified as one of the major problems among risky populations. METHODS Institutional-based cross-sectional study design was conducted among women living with HIV in Shashemene town public health facilities with a total sample size of 406 from February 1-March 30, 2022. Systematic random sampling technique was employed to select the study subjects. A structured questionnaire and checklist was used to collect data. The collected data were cleaned, coded, and entered into Epi-info version 7.2.5 and exported to statistical package for social science version 24 for analysis. Finally, bi-variable and multivariable logistic regression analyses were performed to identify determinants of high-risk human papillomavirus. Odds ratio with 95% confidence interval was used to test association between exposure and outcome under study and p-value < 0.05 was considered significant. RESULTS The prevalence of high-risk HPV infections among study participant was 173(35.2%) with 95% CI (30.5%-40.1%). Prevalence of high-risk HPV type 16, 18 and other high-risk HPV types were 62(15.3%), 23(5.7%) and 58(14.3%), respectively. Having history of sexually transmitted infections [AOR = 3.120; 95% CI (1.977-4.923)], Endline CD4 count < 200 cells/mm3 [AOR = 3.072; 95% CI(1.009-9.350)], Endline HIV viral-load ≥ 50 copies/ml [AOR = 3.446; 95% CI(1.368-8.683)] and more than one-lifetime sexual partner [AOR = 2.112; 95% CI(1.297-3.441)] were significantly associated with high-risk HPV infections. CONCLUSION More than one third of women living with HIV had high-risk HPV. Having history of STI, low CD4 count, high viral load and multiple sexual partners were associated with high risk HPV. HIV positive women with these risk factors should be given special consideration in clinical and public health intervention.
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Affiliation(s)
- Tariku Megersa
- Shashemene Comprehensive Specialized Hospital, Shashemene, Oromia Regional State, Ethiopia.
| | - Sisay Dango
- Department of Public Health, Madda Walabu University Shashemene Campus, Shashemene, Ethiopia
| | - Kebede Kumsa
- Department of Public Health, Madda Walabu University Shashemene Campus, Shashemene, Ethiopia
| | - Kebebew Lemma
- Shashemene Comprehensive Specialized Hospital, Shashemene, Oromia Regional State, Ethiopia
| | - Bikila Lencha
- Department of Public Health, Madda Walabu University Shashemene Campus, Shashemene, Ethiopia
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9
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Tawe L, Ramatlho P, Ketlametswe R, Koobotse M, Robertson ES, Grover S, Ramogola-Masire D, Paganotti GM. Cervical human papillomavirus genotypes in a high HIV setting: A scoping review of a decade of human papillomavirus epidemiological research in Botswana. Front Med (Lausanne) 2022; 9:1020760. [PMID: 36507502 PMCID: PMC9729273 DOI: 10.3389/fmed.2022.1020760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
Cervical cancer burden is still high in low- and middle-income countries, including Botswana. Persistent human papillomavirus (HPV) infection is the leading cause of cervical cancer. Accurate knowledge of HPV diversity associated to cervical cancer in sub-Saharan Africa may provide accurate understanding of the natural history of HPV infection in these contexts. The goal of this review was to consolidate existing evidence on cervical HPV infection and to conduct a pooled analysis of data from all eligible Botswana studies. After a successful review of twelve studies on cervical HPV genotypes that met the inclusion criteria, HPV-16 genotype was the most frequently discovered in women with pre-cancerous and cancer lesions, followed by HPV-18. HPV-16 in HIV-positive women with precancerous lesions to cancer is between 45% and 47.7%, and between 4.5% and 26.1% for HPV-18. With reference to other HPV genotypes, the proportion of HPV-35 and HPV-58 (13-16%) seems relatively consistent among the studies, however HPV-58 appears to be more common in HIV-positive subjects compared to HIV-negative women. Indeed, HPV-45 seems to be frequently detected in women with cervical cancer compared to women with precancerous lesions. Regarding the low-risk HPV genotypes, an appropriate breakdown has been provided. In conclusion, the current prophylactic vaccines against HPV-16 and HPV-18, which have demonstrated good immunogenicity in HIV-infected populations, may still prevent infection and ultimately cancer.
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Affiliation(s)
- Leabaneng Tawe
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,Office of Research and Graduate Studies, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Pleasure Ramatlho
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,School of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | | | - Moses Koobotse
- School of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | - Erle S. Robertson
- Department of Otorhinolaryngology - Head and Neck Surgery, The Tumor Virology Program, Abramson Comprehensive Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Doreen Ramogola-Masire
- Office of Research and Graduate Studies, Faculty of Medicine, University of Botswana, Gaborone, Botswana,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Giacomo M. Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana,*Correspondence: Giacomo M. Paganotti,
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10
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Vink FJ, Meijer CJLM, Lissenberg-Witte BI, Visser C, Duin S, Snyman LC, Richter KL, van der Merwe FH, Botha MH, Steenbergen RDM, Dreyer G. Validation of ASCL1 and LHX8 Methylation Analysis as Primary Cervical Cancer Screening Strategy in South African Women with Human Immunodeficiency Virus. Clin Infect Dis 2022; 76:416-423. [PMID: 36366827 PMCID: PMC9907555 DOI: 10.1093/cid/ciac801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Compared with women who are human immunodeficiency virus (HIV) negative, women with human immunodeficiency virus (WWH) have a higher human papillomavirus (HPV) prevalence and increased cervical cancer risk, emphasizing the need for effective cervical cancer screening in this population. The present study aimed to validate methylation markers ASCL1 and LHX8 for primary screening in a South African cohort of WWH. METHODS In this post hoc analysis within the DIAgnosis in Vaccine And Cervical Cancer Screen (DiaVACCS) study, a South African observational multicenter cohort study, cervical scrape samples from 411 HIV-positive women were analyzed for hypermethylation of ASCL1 and LHX8 genes, HPV DNA, and cytology. Sensitivities, specificities, and positive and negative predictive values of primary methylation-based, HPV-based and cytology-based screening were calculated for the detection of cervical intraepithelial neoplasia of grade 3 or higher. RESULTS Single markers ASCL1 and LHX8 resulted in a good performance for the detection of cervical intraepithelial neoplasia of grade 3 or higher, with sensitivities of 85.9% (95% confidence interval [CI], 78.2%-93.6%) and 89.7% (83.0%-96.5%), respectively, and specificities of 72.9% (67.3%-78.5%) and 75.0% (69.5%-80.5%). Combining markers ASCL1 and LHX8 resulted in a lower sensitivity compared with HPV testing (84.6% vs 93.6%, respectively; ratio, 0.90 [95% CI, .82-.99]) and a higher specificity (86.7% vs 78.3%; ratio 1.11 [1.02-1.20]) and reduced the referral rate from 46.8% to 33.4%. ASCL1/LHX8 methylation had a significantly higher sensitivity than cytology (threshold, high-grade intraepithelial squamous lesion or worse), (84.6% vs 74.0%, respectively; ratio, 1.16 [95% CI, 1.01-1.32]) and similar specificity (86.7% vs 91.0%; ratio, 0.95 [.90-1.003]). CONCLUSIONS Our results validate the accuracy of ASCL1/LHX8 methylation analysis for primary screening in WWH, which offers a full-molecular alternative to cytology- or HPV-based screening, without the need for additional triage testing.
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Affiliation(s)
- Frederique J Vink
- Department of Pathology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Correspondence: C. J. L. M. Meijer, Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands ()
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cathy Visser
- Gynaecologic Oncology Unit, Department of Obstetrics & Gynaecology, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Sylvia Duin
- Department of Pathology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Leon C Snyman
- Gynaecologic Oncology Unit, Department of Obstetrics & Gynaecology, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Karin L Richter
- Department of Medical Virology, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Frederick H van der Merwe
- Gynaecologic Oncology Unit, Department of Obstetrics & Gynaecology, Stellenbosch University Faculty of Health Sciences, Stellenbosch, South Africa
| | - Matthys H Botha
- Gynaecologic Oncology Unit, Department of Obstetrics & Gynaecology, Stellenbosch University Faculty of Health Sciences, Stellenbosch, South Africa
| | - Renske D M Steenbergen
- Department of Pathology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
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11
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Friebel-Klingner TM, Bazzett-Matabele L, Ramogola-Masire D, Monare B, Ralefala TB, Seiphetlheng A, Ramontshonyana G, Vuylsteke P, Mitra N, Wiebe DJ, Rebbeck TR, McCarthy AM, Grover S. Distance to Multidisciplinary Team Clinic in Gaborone, Botswana, and Stage at Cervical Cancer Presentation for Women Living With and Without HIV. JCO Glob Oncol 2022; 8:e2200183. [PMID: 36395437 PMCID: PMC10166426 DOI: 10.1200/go.22.00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/20/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Cervical cancer is the leading cause of cancer death for women in Botswana. Barriers in access to cancer care can lead to later stages at diagnosis and increased mortality. This study evaluated access, defined as travel time from a patient's residential village to a multidisciplinary team clinic in Gaborone, with stage of cervical cancer at presentation. In addition, because of the high HIV prevalence in Botswana, we explored the association between travel time and HIV status. METHODS Eligible patients with cervical cancer presenting to the multidisciplinary team between 2015 and 2020 were included. Data were abstracted from questionnaires and hospital records. Google Maps was used to calculate travel time. Multinomial regression was used to examine travel time and cancer stage, and multivariable logistic regression was used to investigate travel time and HIV status. RESULTS We identified 959 patients with cervical cancer of which 70.1% were women living with HIV. The median travel time was approximately 2 hours. Using a reference group of stage I disease and a travel time of < 1 hour, the odds of presenting with stage II increased for patients traveling 3-5 hours (adjusted odds ratio [OR], 2.00; 95% CI, 1.14 to 3.52) and > 5 hours (OR, 2.19; 95% CI, 1.15 to 4.19). There were no significant associations for stage III. For stage IV disease, the odds were increased for patients traveling 3-5 hours (OR, 2.93; 95% CI, 1.26 to 6.79) and > 5 hours (adjusted OR, 4.05; 95% CI, 1.62 to 10.10). In addition, the odds of patients presenting living with HIV increased with increasing travel time (trend test = 0.004). CONCLUSION This study identified two potential factors, travel time and HIV status, that influence access to comprehensive cervical cancer care in Botswana.
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Affiliation(s)
- Tara M. Friebel-Klingner
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | | | | | | | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Douglas J. Wiebe
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Timothy R. Rebbeck
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, MA
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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12
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Asare M, Abah E, Obiri-Yeboah D, Lowenstein L, Lanning B. HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done? Healthcare (Basel) 2022; 10:1270. [PMID: 35885798 PMCID: PMC9317927 DOI: 10.3390/healthcare10071270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Self-sampling has the potential to increase cervical cancer (CC) screening among women with HIV in low- and middle-income countries (LMICs). However, our understanding of how HPV self-collection studies have been conducted in women with HIV is limited. The purpose of this scoping review was to examine the extent to which the HPV self-sampling has been applied among women with HIV in LMICs. METHOD We conducted multiple searches in several databases for articles published between 2000 and January 2022. With the combination of keywords relating to HPV self-sampling, LMICs, and women with HIV, we retrieved over 9000 articles. We used pre-defined inclusion and exclusion criteria to select relevant studies for this review. Once a study met the inclusion criteria, we created a table to extract each study's characteristics and classified them under common themes. We used a qualitative descriptive approach to summarize the scoping results. RESULTS A total of 12 articles were included in the final review. Overall, 3178 women were enrolled in those studies and 2105 (66%) of them were women with HIV. The self-sampling participation rate was 92.6%. The findings of our study show that 43% of the women with HIV in 8 of the studies reviewed tested positive for high-risk HPV (hr-HPV) genotypes, indicating 4 out of 10 women with HIV in the studies are at risk of cervical cancer. The prevalence of the hr-HPV in women with HIV was 18% higher than that of HIV-negative women. Most women in the study found the self-sampling experience acceptable, easy to use, convenient, and comfortable. Self-sampling performance in detecting hr-HPV genotypes is comparable to clinician-performed sampling. However, limited access (i.e., affordability, availability, transportation), limited knowledge about self-screening, doubts about the credibility of self-sampling results, and stigma remain barriers to the wide acceptance and implementation of self-sampling. In conclusion, the findings of this review highlight that (a) the prevalence of hr-HPV is higher among women with HIV than HIV-negative women, (b) self-sampling laboratory performance is similar to clinician-performed sampling, (c) the majority of the women participated in self-sampling, which could likely increase the cervical cancer screening uptake, and (d) women with HIV reported a positive experience with self-sampling. However, personal, environmental, and structural barriers challenge the application of self-sampling in LMICs, and these need to be addressed.
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Affiliation(s)
- Matthew Asare
- Robbins College of Health and Human Services, Department of Public Health, Baylor University, Waco, TX 76798, USA; (E.A.); (B.L.)
| | - Elakeche Abah
- Robbins College of Health and Human Services, Department of Public Health, Baylor University, Waco, TX 76798, USA; (E.A.); (B.L.)
| | - Dorcas Obiri-Yeboah
- School of Medical Sciences, Department of Microbiology and Immunology, University of Cape Coast, Cape Coast, P.O. Box University Mail, Ghana;
| | - Lisa Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Beth Lanning
- Robbins College of Health and Human Services, Department of Public Health, Baylor University, Waco, TX 76798, USA; (E.A.); (B.L.)
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13
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Seyoum A, Assefa N, Gure T, Seyoum B, Mulu A, Mihret A. Prevalence and Genotype Distribution of High-Risk Human Papillomavirus Infection Among Sub-Saharan African Women: A Systematic Review and Meta-Analysis. Front Public Health 2022; 10:890880. [PMID: 35875040 PMCID: PMC9304908 DOI: 10.3389/fpubh.2022.890880] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Among sub-Saharan African women, cervical cancer is steadily increasing with more than 75,000 new cases and 50,000 deaths annually. Due to the vast ethno geography variation, Africa harbors heterogeneous genotypes of HPV. High-risk HPV [hr HPV] genotypes such as hr HPV-16,−18,-35, and−52 are abundantly reported in sub-Saharan Africa. The purpose of this systematic review and meta-analysis is to generate an evidence on the prevalence and the genotype distribution of hr HPV among sub-Saharan African countries. Methods The review was conducted by following the preferred reporting items for systematic reviews and Meta-analysis. PubMed/Medline, Embase, Scopus, Google Scholar, Heath Technology assessment and Cochrane Library databases were used to retrieve published original studies between 2001 and 2021. It included studies that used PCR-based or hybrid testing to assess the presence of HPV DNA in a cervical biopsy, cervical swelling, and vaginal swelling. Statistical software for data science (STATA V16) software using a random-effects model was used to determine the pooled prevalence and type-specific distribution of HPV with 95% confidence intervals (CI). The I-squared statistic was used to describe the level of heterogeneity. The study protocol is registered on PROSPERO with reference number CRD42022311157. Results The review included 27 studies conducted in 19 sub-Saharan countries. A total of 16,506 study participants from 27 studies were included in a systematic review and 5,303 of them were infected with the hr HPV infection. Out these, only 3,075 of them were eligible for meta-analysis. The incidence proportion of estimatesof hr HPV infection among study participants with different health conditions ranges from 10.7 to 97.2% while the pooled incidence proportion of estimates is 34% (95%CI: 29–39). Among 3,075 women, 424 (13.8%), 305 (9.9%) and 279 (9%) were infected with HPV-16,−52 and−18, respectively. HPV-16 and−52 are the main genotypes causing the hr HPV infection in the Eastern and Southern African sub-contents, whereas HPV-16 and−35 are the main genotypes in the Western African countries. Conclusions Depending on several factors, especially women's health conditions, the high rate of hr HPV infection with inconsistent genotype distribution shows that it is a growing public health challenge in sub-Saharan African countries. Therefore, to implement a vaccination-based prevention strategy and be effective, considering factors associated with hr HPV infection is crucial.
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Affiliation(s)
- Ayichew Seyoum
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- *Correspondence: Ayichew Seyoum
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Gure
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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14
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Phase I of the DiaVACCS screening trial: Study design, methods, population demographics and baseline results. S Afr Med J 2022. [DOI: 10.7196/samj.2022.v112i7.16478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Human papillomavirus (HPV)-based primary screening guidelines are based on screening test performance and prevalence data generated in high-resource areas with low HIV infection rates. There is an urgent need for local data on infection and disease prevalence, as well as screening test performance, among both HIV-positive and HIV-negative South African (SA) women, in order to inform updated screening guidelines.
Objectives. This study describes the baseline characteristics of participants in the cross-sectional phase of the multicentric DIAgnosis in Vaccine And Cervical Cancer Screen (DiaVACCS) screening trial. The objective was to determine the prevalence of positive screening and pre-invasive disease using different tests and strategies in the SA HIV-positive and HIV-negative population.Methods. A total of 1 104 women aged 25 - 65 years and eligible for screening were included, 465 HIV positive and 639 HIV negative. Visual inspection and molecular and cytological screening tests were done on self-sampled and healthcare worker-collected specimens. All participants who screened positive and 49.1% of those who screened negative were invited for colposcopy and biopsy, and those qualifying for treatment were recalled for large loop excision of the transformation zone as part of the trial. The worst histology result for each participant was used, and for untested women, multiple imputation was used to estimate verification bias- adjusted histology values.
Results. Visual inspection was positive in 50.4% of HIV-positive v. 20.9% of HIV-negative women, cytology (atypical squamous cells of undetermined significance) in 39.9% v. 17.0%, and high-risk HPV DNA in 41.2% v. 19.6%. Overall, high-grade squamous intraepithelial lesion-positive cytology peaked in the age group 30 - 39 years at 16.7%. After adjustment for verification bias, histological diagnosis of cervical intraepithelial neoplasia (CIN)2+ was suspected in 44.7% v. 23.5% and CIN3+ in 23.3% v. 10.2% of HIV-positive and negative women, respectively. Invasive cancer was diagnosed in 15 women (1.95% of histological studies performed), and verification bias adjustment suggested 20 cases (1.8% of the study population).
Conclusion. The baseline findings from the DiaVACCS trial confirm a high prevalence of HPV-related cervical pathology in the SA HIV-negative screening population, showing a clear need to reach these women with a screening programme. Among HIV-positive women, prevalence values were almost doubled. The prevalence of existing invasive cervical cancer was 1 - 2% of all women. Further analysis of the performance of single and multiple screening tests between the two subgroups will contribute to the choice of the most effective strategies to identify women at risk of developing invasive cancer.
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15
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Ramogola-Masire D, Luckett R, Dreyer G. Progress and challenges in human papillomavirus and cervical cancer in southern Africa. Curr Opin Infect Dis 2022; 35:49-54. [PMID: 34873079 DOI: 10.1097/qco.0000000000000805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Although cervical cancer is preventable, it is the leading cancer among women in southern Africa. The association of high-risk human papillomavirus (HR-HPV) with almost all invasive cervical cancers has led to the development of effective primary and secondary prevention measures. This review focuses on updated and new evidence of the epidemiology of HPV and HPV-based secondary prevention in southern Africa. RECENT FINDINGS HR-HPV prevalence in southern Africa differs between regions, and varies most by HIV prevalence and age. HR-HPV prevalence among women living with HIV (WLWH) is reported between 29 and 59.7%, and between 16.2 and 25.2% among women without HIV. HPV16 is the most common HR-HPV type present in invasive cervical cancers in the region; and vaccination may potentially prevent approximately 80% of these cancers. Concerning preliminary data suggests faster development of new cervical precancer within a short follow-up period. SUMMARY We need tools that identify the small number of women with precancer from the many with transient HR-HPV infection in southern Africa. The high-volume of test-positive women leads to challenges in managing triage in a HR-HPV-based screening program. Longitudinal data from the entire region is urgently needed to guide effective implementation of HPV-based screening programs.
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Affiliation(s)
- Doreen Ramogola-Masire
- Department of Obstetrics & Gynecology, University of Botswana, Gaborone, Botswana
- Gynaecologic Oncology Unit, Department of Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Rebecca Luckett
- Department of Obstetrics & Gynecology, University of Botswana, Gaborone, Botswana
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Greta Dreyer
- Gynaecologic Oncology Unit, Department of Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
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16
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Abstract
Human papillomavirus is the most common sexually transmitted infection in the world and had been linked to both anogenital and oropharyngeal cancers. It causes nearly 100% of cervical cancers and an increasing portion of oropharyngeal cancers. The geographical burden of cervical HPV infection and associated cancers is not uniform and is mainly found in low middle income countries in South America, Africa, and Asia. However, HPV-positive oropharyngeal cancer is rapidly becoming more prevalent in high middle income countries. With the development of vaccines which prevent HPV infection, the World Health Organization has designated the extirpation of HPV and its associated cancers a priority. Countries that have implemented adequate vaccine programs have shown a decrease in HPV prevalence. Understanding the epidemiology of HPV and its associated cancers is fundamental in improving vaccine programs and other health programs.
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Affiliation(s)
- Nicholas Scott-Wittenborn
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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17
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Friebel-Klingner TM, Luckett R, Bazzett-Matabele L, Ralefala TB, Monare B, Nassali MN, Ramogola-Masire D, Bvochora M, Mitra N, Wiebe D, Rebbeck TR, McCarthy AM, Grover S. Clinical and sociodemographic factors associated with late stage cervical cancer diagnosis in Botswana. BMC Womens Health 2021; 21:267. [PMID: 34229672 PMCID: PMC8259023 DOI: 10.1186/s12905-021-01402-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/22/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of female cancer mortality in Botswana with the majority of cervical cancer patients presenting with late-stage disease. The identification of factors associated with late-stage disease could reduce the cervical cancer burden. This study aims to identify potential patient level clinical and sociodemographic factors associated with a late-stage diagnosis of cervical cancer in Botswana in order to help inform future interventions at the community and individual levels to decrease cervical cancer morbidity and mortality. RESULTS There were 984 women diagnosed with cervical cancer from January 2015 to March 2020 at two tertiary hospitals in Gaborone, Botswana. Four hundred forty women (44.7%) presented with late-stage cervical cancer, and 674 women (69.7%) were living with HIV. The mean age at diagnosis was 50.5 years. The association between late-stage (III/IV) cervical cancer at diagnosis and patient clinical and sociodemographic factors was evaluated using multivariable logistic regression with multiple imputation. Women who reported undergoing cervical cancer screening had lower odds of late-stage disease at diagnosis (OR: 0.63, 95% CI 0.47-0.84) compared to those who did not report screening. Women who had never been married had increased odds of late-stage disease at diagnosis (OR: 1.35, 95% CI 1.02-1.86) compared to women who had been married. Women with abnormal vaginal bleeding had higher odds of late-stage disease at diagnosis (OR: 2.32, 95% CI 1.70-3.16) compared to those without abnormal vaginal bleeding. HIV was not associated with a diagnosis of late-stage cervical cancer. Rural women who consulted a traditional healer had increased odds of late-stage disease at diagnosis compared to rural women who had never consulted a traditional healer (OR: 1.61, 95% CI 1.02-2.55). CONCLUSION Increasing education and awareness among women, regardless of their HIV status, and among providers, including traditional healers, about the benefits of cervical cancer screening and about the importance of seeking prompt medical care for abnormal vaginal bleeding, while also developing support systems for unmarried women, may help reduce cervical cancer morbidity and mortality in Botswana.
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Affiliation(s)
- Tara M Friebel-Klingner
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Rebecca Luckett
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics and Gynecology, Princess Marina Hospital, Gaborone, Botswana
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
| | - Tlotlo B Ralefala
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Mercy Nkuba Nassali
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Memory Bvochora
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas Wiebe
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Timothy R Rebbeck
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana.
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
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18
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Luckett R, Painter H, Hacker MR, Simon B, Seiphetlheng A, Erlinger A, Eakin C, Moyo S, Kyokunda LT, Esselen K, Feldman S, Morroni C, Ramogola-Masire D. Persistence and clearance of high-risk human papillomavirus and cervical dysplasia at 1 year in women living with human immunodeficiency virus: a prospective cohort study. BJOG 2021; 128:1986-1996. [PMID: 34008294 DOI: 10.1111/1471-0528.16758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Evaluate 1-year outcomes of cervical cancer screening and treatment using primary high-risk human papillomavirus (HPV) testing in women living with human immunodeficiency virus (HIV). DESIGN Prospective cohort study. SETTING HIV treatment centre in Botswana. POPULATION Women living with HIV. METHODS Participants underwent cervical cancer screening with high-risk HPV testing and triage evaluation at baseline and 1-year follow up. Excisional treatment was offered as indicated. Histopathology was the reference standard. MAIN OUTCOME MEASURES Persistence, clearance and incidence of high-risk HPV infection; and persistence, progression, regression, cure and incidence of cervical dysplasia. RESULTS Among 300 women screened at baseline, 237 attended follow up (79%). High-risk HPV positivity significantly decreased from 28% at baseline to 20% at 1 year (P = 0.02). High-risk HPV persistence was 46% and clearance was 54%; incidence was high at 9%. Prevalence of cervical intraepithelial neoplasia Grade 2 (CIN2) or higher was most common in participants with incident high-risk HPV (53%). CIN2 or higher was also common in those with persistent high-risk HPV (32%) and even in those who cleared high-risk HPV (30%). Of the high-risk HPV-positive participants at baseline with <CIN2, 40% progressed to CIN2 or higher at follow up. CONCLUSION The high incidence of high-risk HPV and high-grade cervical dysplasia in women living with HIV after one round of high-risk HPV-based screening and treatment raises concern about the rate of progression of high-risk HPV infection to dysplasia. Persistent disease is common. Caution in spacing cervical cancer screening intervals using high-risk HPV testing in women living with HIV is warranted. TWEETABLE ABSTRACT High incidence and persistence of HPV and CIN2+ in women living with HIV 1 year after screening and treatment.
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Affiliation(s)
- R Luckett
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - H Painter
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - M R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - B Simon
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - A Seiphetlheng
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - A Erlinger
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - C Eakin
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Obstetrics and Gynecology, Creighton University School of Medicine-Phoenix, Phoenix, AZ, USA
| | - S Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - L T Kyokunda
- Department of Pathology, University of Botswana, Gaborone, Botswana
| | - K Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - S Feldman
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - C Morroni
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - D Ramogola-Masire
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
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19
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Castle PE, Ajeh R, Dzudie A, Kendowo E, Fuhngwa N, Simo-Wambo AG, Nsame D, Orock E, Hebert TM, Pierz AJ, Murokora D, Anastos K, Adedimeji A. A comparison of screening tests for detection of high-grade cervical abnormalities in women living with HIV from Cameroon. Infect Agent Cancer 2020; 15:45. [PMID: 32676125 PMCID: PMC7353796 DOI: 10.1186/s13027-020-00311-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/02/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Women living with human immunodeficiency virus (WLWH), especially those living in low- and middle-income countries (LMIC), are at increased risk of cervical cancer. The optimal cervical-cancer screening strategy for WLWH has not been determined. We therefore conducted a pilot study of screening methods in WLWH living in Limbe, Cameroon. METHODS Five-hundred sixty-six WLWH, aged 25-59 years, were enrolled. After self-collecting a cervicovaginal specimen, they underwent a pelvic exam, during which a provider also collected a cervical specimen and visual inspection after acetic acid (VIA) was performed. Both self- and provider-collected specimens were tested for high-risk HPV by the Xpert HPV Test (Cepheid, Sunnyvale, CA, USA), with the residual of the latter used for liquid-based cytology. Women testing HPV positive on either specimen and/or VIA positive were referred to colposcopy and biopsies. However, because of poor attendence for follow-up colposcopy for the screen positives due to civil strife and technical issues with biopsies, high-grade cytology and/or clinical diagnosis of cancer was used as the primary high-grade cervical abnormality endpoint. Clinical performances for high-grade cervical abnormality of HPV testing and VIA for screening WLWH, and the most carcinogenic HPV genotypes and/or VIA to triage high-risk HPV-positive WLWH, were evaluated. RESULTS Four-hundred eighty-seven (86.0%) WLWH had results for HPV testing on both specimen, VIA, and cytology and were included in the analysis. Forty-nine (10.1%) had a high-grade cervical abnormality. HPV testing on provider- and self-collected specimens was more sensitive than VIA (95.9 and 91.8% vs. 43.8%, respectively, p < 0.01 for both comparisons) for identifying women with high-grade cervical abnormalities. HPV testing on provider- and self-collected specimens was less specific than VIA (57.5 and 51.6% vs. 89.7%, respectively, p < 0.01 for both comparisons) for identifying women with high-grade cervical abnormalities; HPV testing on provider-collected specimens was more specific than on self-collected specimens (p < 0.01). Among HPV-positive women, HPV16/18/45 detection or VIA positivity had a sensitivity and positive predictive value of 73.5 and 29.0%, respectively, for provider-collected specimens and 68.8 and 22.9%, respectively, for self-collected specimens for high-grade cervical abnormalities. CONCLUSIONS HPV testing was more sensitive but less specific than VIA for detection of high-grade cervical abnormality in WLWH. Improved triage methods for HPV-positive WLWH are needed. TRIAL REGISTRATION NCT04401670 (clinicaltrials.gov); retrospectively registered on May 26, 2020.
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Affiliation(s)
- Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Rogers Ajeh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Ernestine Kendowo
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Norbert Fuhngwa
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | | | - Denis Nsame
- Limbe Regional Hospital, Limbe, Southwest Region Cameroon
| | - Enow Orock
- Department of Biomedical Sciences, University of Buea, Buea, Cameroon
| | - Tiffany M. Hebert
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Amanda J. Pierz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
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20
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Adedimeji A, Ajeh R, Dzudie A, Kendowo E, Fuhngwa N, Nsame D, Simo-Wambo AG, Orock E, Hebert TM, Pierz AJ, Murokora D, Anastos K, Castle PE. Cervical human papillomavirus DNA detection in women living with HIV and HIV-uninfected women living in Limbe, Cameroon. J Clin Virol 2020; 128:104445. [PMID: 32470891 DOI: 10.1016/j.jcv.2020.104445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND There are limited data on cervical HPV prevalence in Cameroon and none from its Anglophone region. We investigated cervical HPV prevalence in HIV-uninfected (HIV[-]) and HIV-infected (WLWH) women living in the region. METHODS A convenience sample of consecutively recruited HIV[-] women (n = 295) and women living with HIV (WLWH) (n = 560) attending the Limbé Regional Hospital were enrolled into a cervical screening study. Women underwent screening that included HPV testing of self-collected and provider-collected specimens. We calculated the HPV prevalence by HIV status, overall and stratified by age, and among WLWH, stratified by CD4 counts. We compared the concordance for the detection of HPV between self- and provider-collected specimens. RESULTS Crude HPV prevalence was 21.69 % (95 % confidence interval [95 %CI] = 17.21-26.48 %) for HIV[-] women and 46.43 % (95 %CI = 42.24-50.66 %) for WLWH (p < 0.001). Among WLWH, older age (ptrend = 0.01) and higher CD4 counts (ptrend = 0.007) were associated with lower HPV prevalence. There was a good-to-excellent agreement for HPV detection between specimens, and self-collected were more likely than provider-collected specimens to test HPV positive, for all women and stratified by HIV status. CONCLUSIONS HIV-related immunosuppression was a risk factor for HPV prevalence in this population. HPV testing of self-collected specimens appeared to be less specific than HPV testing of provider-collected specimens.
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Affiliation(s)
- Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rogers Ajeh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Ernestine Kendowo
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Norbert Fuhngwa
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nsame
- Limbe Regional Hospital, Limbe, Southwest Region, Cameroon
| | | | - Enow Orock
- Department of Biomedical Sciences, University of Buea, Cameroon
| | - Tiffany M Hebert
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amanda J Pierz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
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