Prevalence and factors associated with high-risk human papillomavirus among women living with HIV attending a rural hospital in Uganda: a 2024 cross-sectional survey
Abstract
Human papillomavirus (HPV) is now known to be the main factor in the aetiology of cervical cancer, particularly among HIV-positive women(WLHIV). Despite this risk, the factors associated with high risk HPV(hrHPV) infection in this population are poorly understood. We explored these factors to inform the design of effective, targeted screening and intervention strategies that are tailored to the unique risks faced by WLHIV. We conducted a cross-sectional study among reproductive age WLHIV receiving care at Kagadi Hospital, Western Uganda. We recruited participants by systematic random sampling and collected data using a pretested, standardized questionnaire. Cervical specimens were obtained from the participants and tested for hrHPV, using the Cepheid Xpert HPV test on a GeneXpert machine. Descriptive statistics and modified Poisson regression analysis were performed using STATA 17. A total of 213 WLHIV consented to participate in the study, with 85 (39.9%) testing positive for hrHPV. Among those who were hrHPV positive, 11.8% had HPV type 16, 11.8% had HPV type 18/45, 3.5% had both HPV 16 and 18/45, 3.5% had HPV 18/45 and other types and 7.1% had all the tested strains. Key factors significantly associated with increased hrHPV infection risk included being married (aPR = 1.6, 95% CI: 1.1–2.5, p < 0.01), using hormonal contraceptives (aPR = 1.5, 95% CI: 1.1–2.2, p < 0.01), alcohol consumption (aPR = 1.4, 95% CI: 1.1–2.1, p < 0.05), and having a detectable viral load (aPR = 1.7, 95% CI: 1.1–2.5, p < 0.05). The prevalence of hrHPV infection, among WLHIV in rural Western Uganda, was concerningly high at nearly 40%. Intervention strategies for risk mitigation may need to emphasize reduction in alcohol consumption, viral load suppression through adherence to antiretroviral therapy, and expert guided hormonal contraceptive use. Risk associated with marital status may require further investigation.