Increased proportion of “other hrHPV” genotypes other than 16 and 18/45 among women attending ART clinic in Northern Uganda☆

Abstract

Introduction: Cervical cancer, caused by persistent infection with High-Risk Human Papillomavirus (hrHPV) disproportionately affects women living with HIV, moreover with low HPV vaccination coverage and inadequate screening. We conducted this study to determine the prevalence, genotype distribution, and associated factors for hrHPV among women living with HIV, receiving antiretroviral therapy at Gulu Regional Referral Hospital (GRRH). Methods: From August to October of 2024, a cross-sectional descriptive analytical study was carried out at GRRH. We enrolled 346 women living with HIV through convenient sampling. Cervical swab specimens were collected and analyzed for hrHPV genotypes using the CEPHIED GeneXpert HPV assay Model type GX XVI 16 serial number 846215. STATA version 14 was used to analyze quantitative data, and associations were tested using logistic regression considering p values of <0.05 as statistically significant. Findings: Overall, 29.5 % (95 % CI: 24–34 %) of participants had hrHPV. The most prevalent category of HPV genotype was “Other hrHPV” (31, 33, 35, 39, 51, 52, 56, 58, 59, 66, and 68) (75.2 %) while HPV 18/45 and HPV 16 had prevalence of 15.7 % and 9.1 % respectively. Being professionally employed was significantly associated with reduced odds of hrHPV infection (aOR = 0.293, p = 0.037). Although not statistically significant, individuals who were unemployed showed higher odds of hrHPV infection (aOR = 1.779, p = 0.086). Also longer ART duration (61 ≤ months) was associated with reduced odds of hrHPV infection (aOR = 0.512, p = 0.074). Infrequent alcohol consumption appeared associated with increased odds of hrHPV infection, particularly among non-drinkers (aOR = 5.193, p = 0.059) and rare drinkers (aOR = 5.321, p = 0.058). Conclusion: Women on ART at Gulu RRH, Gulu district, had an elevated prevalence of hrHPV especially those HPV genotypes categorized as “Other hrHPV”. Unemployment was associated with increased odds of hrHPV among the study participants. This calls for extended HPV genotyping during screening and customization of HPV vaccination to cover all HPV genotypes.