Objectives Cervical cancer is the leading cause of cancer-related mortality among women in sub-Saharan Africa (SSA). Data on human papillomavirus (HPV) epidemiology in adolescent girls in SSA are essential to inform HPV vaccine policy recommendations for cervical cancer prevention. We assessed the burden of HPV infection, and risk factors for infection, among adolescent girls around the time of sexual debut.
Methods Cross-sectional study of secondary school girls aged 17–18 years in Tanzania. Consenting participants provided samples for HPV and STI testing. Vaginal swabs were tested for 37 HPV genotypes by Roche Linear Array. Logistic regression was used to identify factors associated with HPV infection. Y chromosome was tested as a marker of recent condomless sex.
Results 163/385 girls (42.3%) reported previous penetrative sex. HPV was detected in 125/385 (32.5%) girls, including 84/163 (51.5%) girls reporting previous sex and 41/222 (18.5%) reporting no previous sex. High-risk (HR) genotypes were detected in 70/125 (56.0%) girls with HPV infection. The most common HR genotype was HPV-16 (15/385; 3.9%). The prevalence of other HR HPV vaccine genotypes was between 0.8% and 3.1%. Among 186 girls who reported no previous sex, were negative for Y chromosome, and had no STI, 32 (17%) had detectable HPV. Lactobacillus sp and bacterial vaginosis-associated bacteria were negatively and positively associated, respectively, with HPV.
Conclusions HPV prevalence among adolescent girls around the time of sexual debut was high. However, prevalence of most vaccine genotypes was low, indicating that extending the age range of HPV vaccination in this region may be cost-effective.
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Handling editor Nigel Field
Contributors Conception or design of the work: DWJ, AB, JC, TC, SN, KJB, SF, AA, RJH. Data collection: JI, SN, AA. Data analysis and interpretation: KJB, CHH, RJH, AB, DWJ. Drafting the article: KJB, DWJ. Critical revision of the article: KJB, AA, SF, TC, AB, DWJ. Final approval of the version to be published: DWJ, AB, RJH, CHH, SF, TC, JC, SN, JI, AA, KJB.
Funding This work was supported by the European and Developing Countries Clinical Trials Partnership (project code: SP.2011.41304.066). Additionally, KJB, SF and RJH received salary support through a jointly funded award by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union (MR/R010161/1).
Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests DWJ has received research grants from GSK Biologicals for HPV vaccine-related research.
Patient consent for publication Not required.
Ethics approval The Institutional Review Board of the Institute of Tropical Medicine in Antwerp (867/13), the Ethics Committee of the University Teaching Hospital in Antwerp (13/14/147), the Lake Zone Institutional Review Board in Mwanza (MR/53/100/86) and the National Ethics Committee of the NIMR Coordinating Committee (NIMR/HQ/R.8a/Vol.IX/1544) approved the study protocol.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available upon reasonable request.