Objective The objective of the present study was to assess the prevalence and type-specific distribution of cervical high-risk (HR) human papillomavirus (HPV) among women with normal and abnormal cytology, and to describe risk factors for HR HPV among HIV-positive and HIV-negative women in Tanzania.
Methodology A cross-sectional study was conducted in existing cervical cancer screening clinics in Kilimanjaro and Dar es Salaam. Cervical specimens were obtained from women aged 25–60 years. Samples were shipped to Denmark for cytological examination, and to Germany for HR HPV testing (using Hybrid Capture 2) and genotyping (using LiPaExtra). Risk factors associated with HPV were assessed by multivariable logistic regression analysis.
Result Altogether, 4080 women were recruited with 3416 women contributing data for the present paper, including 609 HIV-positive women and 2807 HIV-negative women. The overall HR HPV prevalence was 18.9%, whereas the HR HPV prevalence in women with high-grade squamous intraepithelial lesions (HSILs) was 92.7%. Among HPV-positive women with HSIL, HPV16 (32.5%) and HPV58 (19.3%) were the the most common types followed by HPV18 (16.7%) and HPV52 (16.7%). Factors associated with HR HPV included younger age, increasing number of partners and early age at first intercourse. Similar risk factors were found among HIV-positive and HIV-negative women. In addition, among HIV-positive women, those with CD4 counts <200 cells/mm3 had an increased risk of HR HPV (OR 2.2; 95% CI 1.2 to 4.8) compared with individuals with CD4 count ≥500 cells/mm3.
Conclusion Given the HPV distribution among Tanzanian women, the current HPV vaccination in Tanzania using quadrivalent vaccine may be considered replaced by the nonavalent vaccine in the future. In addition, appropriate antiretroviral treatment management including monitoring of viremia may decrease the burden of HR HPV in HIV-positive women.
- cervical cytology
- risk factors
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Handling editor Jonathan Ross
Contributors All authors contributed to the writing of this paper. BLM, SKK, VR and JM made a significant contribution in all steps of the development. RM, PS, MW, TI and CW provided a contribution in drafting specific sections of the manuscript.
Funding The study was funded by the Danish Ministry of Foreign Affairs through Danish International Development Agency (Danida), Danish Fellowship Centre (DFC) with Grant no: 14-P02-Tan/A26775.
Competing interests None declared.
Patient consent for publication Obtained.
Ethics approval This study was approved by the ethical review committee of Tanzanian National Institute of Medical Research (approval no. NIMR/HQ/R.8a/Vol.IX/1955). Fingerprint was used for illiterate subjects.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. All de-identified data relevant to the study may be accessible on reasonable request.