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Prevalence and risk factors for carcinogenic human papillomavirus infections in rural Rakai, Uganda
  1. M Safaeian1,
  2. M Kiddugavu2,
  3. P E Gravitt1,
  4. S J Gange1,
  5. J Ssekasanvu2,
  6. D Murokora2,
  7. M Sklar3,
  8. D Serwadda2,4,
  9. M J Wawer5,
  10. K V Shah6,
  11. R Gray5
  1. 1
    Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
  2. 2
    Rakai Health Sciences Program and Uganda Virus Research Institute, Entebbe
  3. 3
    Mailman School of Public Health, Columbia University, New York, USA
  4. 4
    Institute of Public Health, Makerere University, Kampala, Uganda
  5. 5
    Department of Population, Family and Reproduction Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
  6. 6
    Department of Molecular, Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
  1. Mahboobeh Safaeian, Division of Cancer Epidemiology and Genetics, Hormonal and Reproductive Epidemiology Branch, National Cancer Institute, 6120 Executive Boulevard, Suite 550, Rockville, MD 20852, USA; safaeianm{at}


Objective: To investigate self-administered vaginal swabs for assessing prevalence and correlates of carcinogenic human papillomavirus (HPV) infection in rural Rakai, Uganda.

Methods: 1003 sexually experienced women enrolled in a community cohort provided self-administered vaginal swabs collected at annual, home-based surveys. Carcinogenic HPV prevalence, adjusted odds ratios (AOR), 95% confidence intervals (CI) and associated risk factors were determined.

Results: Carcinogenic HPV prevalence was 19.2%: 46.6% among HIV positive and 14.8% among HIV negative women (p<0.001). Type-specific prevalence ranged from 2.0% (HPV 16 and 52) to 0.2% (HPV 31). Age-specific HPV prevalence decreased significantly (p<0.001) among HIV negative women; however, the decrease among HIV positive women was not as pronounced (p = 0.1). Factors independently associated with carcinogenic HPV infection were HIV (AOR 4.82, CI 3.10 to 7.53), age (AOR 4.97, 95% CI 2.19 to 11.26 for 15–19 year olds compared to 40+ years), more than two sex partners in the past year (AOR 2.21, CI 1.10 to 4.43) and self-reported herpes zoster, candidiasis or tuberculosis (AOR 4.52, CI 1.01 to 20.31). Married women were less likely to have prevalent carcinogenic HPV (AOR 0.46, CI 0.30 to 0.70).

Conclusions: HPV prevalence and correlates measured using self-administered vaginal swabs were similar to studies that use cervical samples. Thus, self-collection can be used as a substitute for cervical specimens and provide an important tool for research in populations unwilling to undergo pelvic exam.

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  • Funding: The Rakai study was funded through grants R01 A134826 and R01 A134265 from the National Institute of Allergy and Infectious Diseases; grant 5P30HD06826 from the National Institute of Child and Health Development; the World Bank STI Project, Uganda; the Henry M. Jackson Foundation; a grant 5D43TW00010 from the Fogarty Foundation; and the Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins University. The HPV substudy was funded by an NCI HIV Associated Malignancies Grant and the STD Training grant (NIH/NIAID T32AI50056). Roche Diagnostics provided the reagents and line blots for the genotyping assay, and Digene Corporation provided the HC2 probe B kits at reduced costs. MS received the Fogarty HIV Associated Malignancies, New and Minority Investigator Award, Fogarty AIDS Training and Research Program, Johns Hopkins University. She was also supported by the STI Training Grant NIH/NIAID T32AI50056.

  • Competing interests: None.

  • Ethics approval: The study was approved by institutional review boards in Uganda and at Johns Hopkins and Columbia Universities.

  • Contributors: MS conducted the laboratory assays, data management, analyses and manuscript preparation. MK, JS and DM were in charge of the field activities and sample collection in Uganda. PEG, SJG, KVS and RG were members of MS’s thesis committee and contributed to the study design and manuscript preparation. MS trained the local gynaecologist to conduct cervical exams, and DS and MJW are the PIs of the ongoing Rakai community cohort study and contributed by providing guidance and feedback in manuscript preparation.