Prevalence of human papillomaviruses in self-collected samples among women attending antenatal care in Ethiopia: a cross-sectional study

Cervical cancer is the second most commonly diagnosed cancer in women in Ethiopia. However, data are limited on the prevalence of human papillomavirus (HPV) genotypes. Self-sampled vaginal lavages were obtained consecutively from 783 women attending 7 health facilities across Ethiopia. Genotype prevalence was assessed by Multiplex-Papillomavirus-Genotyping which detects and individually identifies 51 genotypes and 3 subtypes. Genotype-specific prevalence was described and associations with known risk factors were analysed. The overall HPV prevalence (age range 18-45) was 33.1% (95% confidence interval (CI) 29.8-36.4). The prevalence of HPV was different in the rural and urban population with 17.6% (95%CI 11.6-23.7) and 36.8% (95%CI 33.1-40.6) (p < 0.001 chi-square test), respectively. The most common high-risk types were HPV 16 (6.6%), followed by HPV 52 (4.3%), 51 and 39 (both 2.9%). Urban women compared to rural women had a higher risk of being HPV positive (odds ratio 2.36 (95% CI 1.47-3.79; p < 0.001). Age at sexual debut <= 15 years and polygamous husband (in urban women) also increased the risk of being HPV positive nearly two-fold. The high prevalence of hr-HPV in Ethiopian women in the reproductive age group shows the need for screening programs. The nonavalent HPV vaccine covers the most prevalent hr-HPV genotypes as found in this study and can therefore be used effectively. Since antenatal care is the best-utilised health service, implementing self-sampled vaginal lavage could be an opportunity for screening in this age group. Screening algorithms and triage still need to be defined to avoid over-treatment in these women.