Title : Breaking the cervical cancer–HIV syndemic: High-Risk hpv prevalence and intervention opportunities among women living with HIV in western Uganda
Abstract:
Background: Cervical cancer remains an urgent global health threat, especially among women living with HIV (WLHIV), where the persistence of high-risk human papillomavirus (hrHPV) significantly heightens progression risk. Despite this syndemic, few studies have elucidated the intersecting sociodemographic, behavioral, and clinical drivers of hrHPV in WLHIV—data critical for designing tailored prevention strategies.
Objectives: This study aims to quantify hrHPV prevalence and elucidate associated risk and protective factors among WLHIV attending the ART clinic at Kagadi Hospital, Uganda, to inform equitable, scalable public health interventions.
Methods: In a systematic cross-sectional design, 213 HIV-positive women aged 18–49 were recruited. Participants underwent testing for hrHPV using the Cepheid Xpert HPV assay on a GeneXpert platform. Data collected via pretested questionnaires covered sociodemographics, alcohol and contraceptive use, and viral load status. Analyses employed descriptive statistics and modified Poisson regression in STATA 17 to derive adjusted prevalence ratios (aPR) with 95% confidence intervals.
Results: The overall hrHPV prevalence was 39.9% (85/213). Among hrHPV-positive women:
- Other hrHPV types: 60.0%
- HPV 16: 11.8%
- HPV 18/45: 11.8%
- Multiple-strain infections (including combinations of types): 17.4%
Risk factors associated with increased hrHPV prevalence included:
- Married status (aPR = 1.6; 95% CI: 1.1–2.5; p < 0.01)
- Hormonal contraceptive use (aPR = 1.5; 95% CI: 1.1–2.2; p < 0.01)
- Alcohol consumption (aPR = 1.4; 95% CI: 1.1–2.1; p < 0.05)
Conversely, viral suppression (non-detectable vs detectable) was protective (aPR = 0.6; 95% CI: 0.4–0.9; p < 0.05).
Conclusions: With over one-third of WLHIV at Kagadi Hospital testing positive for hrHPV, the findings emphasize a critical public health priority. The identification of modifiable risk factors—especially hormonal contraceptive use and alcohol intake and the protective role of viral suppression support targeted integration of services. Recommendations include routine hrHPV screening in ART programs, enhanced counselling on contraception and alcohol use, and strengthening viral load adherence support.
