High-risk human papillomavirus positivity and associated factors among women living with HIV in public health facilities of Mekelle, Northern Ethiopia

Abstract

BACKGROUND: Worldwide, it is believed that high-risk human papillomavirus (hr-HPV) strains are the root cause of many types of cancers, including cervical cancer, anorectal cancers, vaginal cancers, and penile cancers, with an estimated 922, 728 females diagnosed with HPV-related cancer in 2022. Particularly, in sub-Saharan Africa, the majority of women (55.13%) were affected by hr-HPV, and human immunodeficiency virus (HIV)-positive women have had double-fold higher risk of hr-HPV infection. Evidence is scarce in the study area; therefore, the current study aimed to assess the prevalence of hr-HPV and associated factors among HIV-positive women in public health facilities of Mekelle, Tigray, northern Ethiopia. METHODS: A health facility-based cross-sectional study was conducted in five conveniently selected public health facilities of Mekelle, northern Ethiopia, from December 10, 2024, to July 10, 2025. The study included 390 consecutively recruited HIV-positive women, from whom questionnaire-based interviews were made, and provider-collected cervical brush specimens were processed using the Abbot cervi-collect kit in accordance with standard procedures. Following automated deoxyribonucleic acid (DNA) extraction using the Abbot m2000sp, the presence of 14 hr-HPV genotypes was detected using the m2000rt real-time polymerase chain reaction (RT-PCR) assay. Bivariate and multivariate logistic regression analyses were performed to assess the statistical association between the potential factors and hr-HPV status. Finally, statistical significance was declared at p < 0.05, along with the corresponding 95% confidence interval. RESULT: . According to the RT-PCR, the overall prevalence of hr-HPV DNA positivity was 39.7% (155/390); [95% CI: 34.9-44.9%]. Specifically, the prevalence of HPV-16, HPV-18, and collectively the other hr-HPV types was 10.8% [95% CI: 7.7-13.8%], 3.6% [95% CI: 1.8-5.6%], and 32.7% [95% CI: 27.9-37.2%], respectively. In multivariable logistic regression analysis, condom use was assocatied with lower odds of hr-HPV infection [AOR = 0.23; 95%CI: 0.06-0.89; p = 0.034], whereas oral contraceptive use [AOR = 4.47; 95%CI: 1.39-14.28; p = 0.012], history of vaginal discharge [AOR = 2.61; 95%CI: 1.01-6.70; p = 0.046], genital ulcer disease [AOR = 4.09; 95%CI: 1.12-14.59; p = 0.030], history of unprotected sex before marriage [AOR = 2.20; 95%CI: 1.14-4.24; p = 0.017], lack of awareness about HPV-linked cervical cancer [AOR = 2.23; 95%CI: 1.18-4.24; p = 0.013], duration ( less than or equal to11 years) since ART initiation [AOR = 2.05; 95%CI: 1.13-3.74; p = 0.018], a history of 3 or more documented ART interruption events [AOR = 4.37; 95CI: 1.06-17.99; p = 0.041], and having detectable recent HIV viral load (40 copies/mL or greater) [AOR = 6.89; 95%CI: 2.75-17.28; p < 0.001] were independently associated with higher odds of hr-HPV infection. CONCLUSION: The findings of the current study indicate a high burden (39.7%) of oncogenic HPV strains among HIV-positive women, though lower than the pooled estimates in sub-Saharan Africa. Notably, HPV-16 and the non-HPV-16/18 high-risk genotypes collectively accounted for the majority of infections. Factors that influenced the presence of high-risk HPV included a history of unprotected sex before marriage, oral contraceptive use, vaginal discharge, genital ulcer disease, lack of awareness regarding HPV and cervical cancer, a shorter duration since ART initiation, frequent ART interruptions, and detectable recent HIV viral loads.