HPV prevalence among young adult women living with and without HIV in Botswana for future HPV vaccine impact monitoring

Abstract

Introduction In 2015, Botswana introduced quadrivalent human papillomavirus (HPV) vaccine for girls aged 9–13 years. To establish a baseline HPV prevalence for future HPV vaccine impact monitoring, we evaluated HPV prevalences among the youngest unvaccinated women in Botswana and compared HPV prevalences among women living with HIV (WLHIV) and without HIV. Methods Women aged 18–22 years were recruited from the University of Botswana and HIV clinics in Gaborone from October 2019–January 2021. Demographic and behavioral characteristics were self-reported during structured interviews; HIV clinical characteristics were abstracted from medical charts. Self-collected vaginal swabs were tested for 28 HPV types using Seegene Anyplex II HPV28. We compared prevalence of any HPV, high risk (HR)-HPV, and quadrivalent HPV vaccine types (HPV6/11/16/18) among WLHIV and women without HIV and evaluated risk factors for prevalence of HR-HPV. Results A total of 306 WLHIV and 500 women without HIV were recruited. Compared to women without HIV, WLHIV were more likely to be sexually experienced (86.6% versus 74.4%) and have ≥ 3 lifetime sex partners (55.3% versus 27.8%). All HPV type prevalences were significantly higher among WLHIV compared to women without HIV, including prevalence of any HPV (82.7% versus 63.0%), HR-HPV (72.9% versus 53.8%), and quadrivalent vaccine HPV types (34.3% versus 21.0%). Among WLHIV, there were no differences between those perinatally and non-perinatally infected for HPV prevalences, number of HPV types detected, CD4 count, or viral load. Conclusions Over one-third of WLHIV and nearly a quarter of those without HIV had vaccine-type HPV detected. This study supports need for the national HPV vaccination program in Botswana and provides important baseline data for future evaluation of impact of the program.

Cervical human papillomavirus genotypes in a high HIV setting: A scoping review of a decade of human papillomavirus epidemiological research in Botswana

“…Regardless of the genotyping method used, the positivity rate for HPV-16 in HIV-positive women with precancerous lesions to cancer is between 45% and 47.7% ( 26 , 27 , 29 ), and between 4.5% and 26.1% for HPV-18 ( 26 – 29 ). These values are much lower (1.5% to 14%, and 0.5% to 15%, for HPV-16 and HPV-18, respectively) when young subjects are studied ( 19 , 20 , 25 ), and this is consistent with the natural history of HPV infection. The results of all genotyping assays were in good agreement for the HPV-16 genotype, whereas different methods showed very different results for HPV-18 genotype ( Table 2 ).…”

“…Twelve studies from Botswana met the criteria for inclusion, with a total of 2,284 young subjects (18 to 22 years of age) who were free of cervical lesions ( 19 , 20 , 25 ); 559 who had cervical cancer or pre-cancer ( 26 – 29 ) and 1,731 who were unclassified as having any malignancies ( 30 – 34 ). Details on each of the included studies are presented in Tables 1 , 2 .…”

“…Four studies (using three different cohorts), totaling 459 cervical cancer cases, examined HPV DNA from biopsies ( 27 – 29 ). Eight studies, totaling 3,945 subjects, examined HPV DNA from cervical cells ( 19 , 20 , 25 , 26 , 31 – 34 ). Finally, one study examined HPV genotypes in 170 women through a serology test ( 30 ).…”

“…In this context, it is critical to clarify that data on the HPV burden in general population of Botswana is still lacking ( 18 ). However, recent data on young university students (aged 18-22 years) show a rate of about 60% HPV positivity ( 19 , 20 ) ( Table 1 ). This evidence emphasizes the need to examine the prevalence of HPV among other age groups in Botswana.…”

Human papillomavirus prevalence in male and female university students in Gaborone, Botswana

“…We recruited a convenience sample of male and female students aged 18–22 years from the University of Botswana, in Gaborone, Botswana from October 2019 to February 2021. A comparison of HPV prevalence among women living with HIV and women without HIV from this study was published previously [ 13 ]. Participants were recruited directly from three main student congregation centres, and indirectly through fliers and notice board announcements.…”