Prevalence of high risk HPV genotypes and associated factors among women living with HIV AIDS in 15 selected Public facilities in Uganda

Background

Women living with HIV are at risk for cervical dysplasia and cancer worldwide. In 2015, the World Health Organization (WHO) recommended that testing for high-risk HPV (hrHPV) infection be incorporated into cervical cancer screening programs using molecular nucleic acid tests (NATs). In Uganda, high-risk HPV has not been institutionalized.

Objective

To determine the prevalence and associated factors of high-risk Human Papilloma Virus genotypes (16, 18-45, and other hrHPV) among women living with HIV in Uganda.

Methods

A cross-sectional descriptive study was conducted in 15 selected health facilities that involved 5856 participants who were on Anti-Retroviral Therapy. Health facilities with a Genexpert machine conducted DNA PCR, whereas those without a Genexpert machine conducted RNA PCR testing. A total of 2032 participants (3 health facilities) were enrolled for HPV RNA testing and 3824 participants (11 health facilities) were enrolled for DNA PCR testing. 

Participants who consented to participate were instructed on how to collect their own high vaginal swabs using a cervical brush. We collected Data on participant demographics using a standard questionnaire. Laboratory diagnosis for HPV DNA and RNA molecular testing was done using Gene xpert MTB/RIF/HPV machines and Hologic Aptima Machine at the 15 selected health facilities sampled across the country in four health regions of Uganda according to Ministry of Health in Uganda.

Results

We enrolled 5856 participants: 3824 (65.3%) on HPV DNA testing and 2032 (34.7%) of whom were enrolled on HPV RNA molecular testing. The prevalence of high-risk Human Papilloma Virus genotypes (HPV16,18-45 and other hr HPV) was 34.3% (2006/5856). Majority of participants were aged 36-49, multiparous and ever been married
19.4% (394/2032) of this was prevalence from HPV RNA testing using Hologic Aptima and 42.2% (1612/3824) from HPV DNA testing using GeneXpert MTB/RIF/HPV system. 

The prevalence of the HPV 16 was 49/2032 (2.4%), 39/2032 (1.9%) for HPV 18-45 and 296/2032 (14.6%) for other hrHPV on HPV RNA genotyping whereas the prevalence of the same genotypes from HPV DNA testing was 268/3824 (7.0%) for HPV 16, 269/3824 (7.0%) for HPV 18-45 and 1075/3824 (28.1%) for other hrHPV.

Conclusions

The prevalence of high-risk HPV genotypes among HIV positive women attending Anti Retroviral Therapy (ART) clinics in the 15 selected public facilities in Uganda was high. Other hr. HPV genotype was the commonest compared to 18-45 and HPV 16. 

Therefore, there is need to scale up HPV molecular testing for high-risk HPV genotypes across the country by integrating it into the normal routine health care services to reduce on the incidence rates of cervical cancer in Uganda.