Genotype distribution of high-risk and potential high-risk HPV types among women in different screening and clinic settings in Ghana and Kenya

Abstract

BACKGROUND: The burden of cervical cancer is highest in Africa. Human papillomavirus (HPV) infection is the major cause of cervical cancer. There are over 200 different HPV genotypes, with 15 considered (potential) high-risk genotypes for developing cancer. Due to a lack of systematic screening programs in most African countries, there is limited data available on the most prevalent HPV genotypes in the population. This study aimed to assess the prevalence and distribution of HPV genotypes in cohorts in Ghana and Kenya. METHODS: We analyzed HPV genotyping data from cervical samples submitted for diagnostic HPV genotype testing between July 2022 and March 2025. Our database contained results from samples obtained from outreach screening events in Accra, the capital of Ghana (n = 680), a research project in Ghana outside of Accra (n = 426), clinician-collected samples submitted through clinics in Ghana (n = 118), samples from participants in Ghana who independently sought HPV genotyping through community-based providers, pharmacies, clinics, or online testing services outside organized screening programmes (n = 181) and samples from an outreach screening event in Kenya (n = 46). All samples were from women 18 years old and above. Positivity for HPV genotypes (HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68) was determined by RT-PCR, using the AmpFire HPV High Risk Genotyping kit. RESULTS: HPV positivity in the Ghana screening group was 34.9%, with multiple genotypes detected in 39.2% of the positive cases. The main HPV genotype in the Ghana screening group was HPV-39 (19.0%), which was especially prevalent in the younger age group (<30 years), followed by HPV-53 (15.2%) and HPV-68 (15.2%). HPV infection (Odds Ratio (OR) 3.09, Confidence Interval (CI) 1.92-4.97, p < 0.001) and infection with multiple genotypes (OR 3.45, CI 1.42-8.38, p = 0.006) was associated with younger age in the Ghana screening group. In the Ghana research group HPV-53 was the most common genotype (18.9%), followed by HPV-39 (18.0%). In the clinician-collected group HPV-16 (18.6%) was the most common genotype. In the self-collected samples from participants who independently sought HPV testing HPV-39 (17.9%) and HPV-51 (17.9%) were the most common genotypes. In the much smaller Kenya screening group HPV-51 (46.2%) was the most prevalent genotype. CONCLUSIONS: Our study shows HPV genotype distribution in different settings. This emphasizes the importance of systematic population-wide HPV screening to understand local HPV infections patterns.