Abstract

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

Methods: 1,003 sexually experienced women enrolled in a community cohort provided self-administered vaginal swab collected at annual, home-based surveys. Carcinogenic HPV prevalence, adjusted odds ratios (AOR), 95% confidence intervals (95%CI), and associated risk factors were determined.

Results: Carcinogenic HPV prevalence was 19.2%; 46.6% among HIV-positive, 14.8% among HIV-negative women (p<0.001). Type-specific prevalence ranged from 2.0% (HPV 16 and 52) to 0.2% (HPV31). Age-specific HPV prevalence decreased significantly (p<0.001) among HIV-negatives, 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; 95%CI: 3.10-7.53), age (AOR=4.97; 95%CI: 2.19-11.26 for 15-19 year olds compared to 40+ years), more than 2 sex partners in the past year (AOR=2.21; 95%CI: 1.10-4.43), and self-reported herpes zoster, candidiasis, or tuberculosis (AOR=4.52; 95%CI: 1.01-20.31). Married women were less likely to have prevalent carcinogenic HPV (AOR=0.46; 95%CI: 0.30-0.70).

Conclusions: HPV prevalence and correlates measured using self-administered vaginal swabs were similar to studies which 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.