Prevalence and Determinants of High-Risk Human Papillomavirus Infection among Women Living in Urban and Rural Communities of Edo State, Nigeria

Abstract

Introduction: Oncogenic human papillomaviruses are predominantly sexually-transmitted pathogens of which several high-risk types are associated with nearly all cases of cervical cancer world especially occurring in women in Sub-Saharan Africa where preventive measures against cervical cancer has been very poor. There are little or very few studies in our setting that have evaluated the various high risk HPV subtypes using polymerase chain reaction, with HPV DNA extraction, amplification and Flow-through hybridization.

This study therefore, aimed to determine the pattern and correlates of high risk human papilloma virus infections in Edo State using pooled data from urban and rural Sub regions of the state as knowledge about the distribution of the HPV types circulating in the communities in different regions of the world would be useful in devising the optimum preventive strategy for high risk HPV infection.

Materials and Methods: This was an analytical cross sectional study of consecutive 290 participants (involving 145 urban and 145 rural participants) in Edo state Nigeria. Enrolled participants who consented to the study were administered structured interviewer questionnaire. Cervical swab sample collection using the female cervical cell collection kit for HPV DNA testing was done to determine the presence of high risk HPV infection. The residual cell suspensions from the female cervical cell collection kit was frozen at -20°C until the desired sample size was achieved. The frozen samples were transported to molecular diagnostics laboratory Nigeria limited, Lagos State Nigeria in iced cold packs for analysis. HPV DNA was detected using the hybribio 21 HPV geno array test kit which uses Polymerase Chain Reaction (PCR), amplification and flow through hybridization.

Results: A total of 290 participants (n=145 urban women and n=145 rural women) were recruited across both settings. The mean age of the participants was 41.0±11.0 and 37.0± 13.0 for urban and rural participants respectively. The overall prevalence for high risk HPV infection in this study was 23(7.9%) with 11(7.6%) in urban and 12(8.3%) in rural communities (p-value = 0.82). The viral serotypes identified in this study within the urban and rural sub regions of Edo state were types 16,18,31,35,45,51,52 and 58. HPV subtypes 16 and 18 contributed the highest prevalence with 45.5% in the urban setting versus 33.3% in the rural setting, with an overall prevalence of 39.1%. Co-infection of 45 and 58 was highest among urban participants (18.2%) while co-infection of 45 and 52 was highest in rural participants (33.3%). Urban women had variable coinfection (35, 45; 45, 52; 45, 58) whereas in rural women, co-infection occurred with Type 45, 52. Sexual activities irrespective of the number of partners and higher parities were statistically associated with a positive high risk HPV status in both urban and rural participants (p-value 0.041), (p-value 0.001) respectively. There was no statistically significant relationship among circumcision, HIV infection, condom use and HPV positivity in both settings.

Conclusion: The prevalence of high risk HPV infection is comparable among women living in urban and rural communities of Edo state Nigeria, however, variations exist in the pattern of occurrence of high risk human papillomavirus subtypes within these sub regions of the State. Strengthening reproductive and sexual education in both males and females with focus on HPV vaccination, delaying sexual activities and reduction in number of childbirth are strategies which would prevent high risk HPV infection and cervical cancer in these communities.