Prevalence and distribution of high risk human papillomavirus genotypes among asymptomatic women in rural Uganda and the association of these genotypes with clinical outcomes: a cross-sectional study

The World Health Organization recommends high-risk human papillomavirus (hrHPV) testing based on genotyping levels, ultimately supporting countries in selecting context-appropriate strategies to prevent cervical cancer in the general population of women. However, hrHPV genotype prevalence, distribution and oncogenic characteristics vary geographically. We studied the distribution of hrHPV genotypes and their relation to screening outcomes among women in rural Uganda. Eligible women aged 30–49 years self-collected vaginal samples, which were tested using GeneXpert ® HPV. Specific genotypes were recorded as positive or negative. All hrHPV-positive women were invited to visual assessment for treatment, with or without visual inspection with acetic acid, and treated accordingly without histopathology. We enrolled 7126 women: 1800 (25·3%) tested hrHPV-positive, and of these, 1422 had complete genotype data. HPV31/33/35/52/58 was present in 324 (22·8%), HPV39/56/66/68 in 243 (17·1%), HPV16 in 183 (12·9%), HPV18/45 in 161 (11·3%), HPV51/59 in 114 (8·0%), and multiple genotypes, in 397 (27·9%). Of the 1121 women who underwent visual inspection with acetic acid, irrespective of genotype, 159 (14·2%) were positive and eight (0·7%) had cervical cancer: six HPV31/33/35/52/58-positive (three also HPV16-, HPV51/59-, or HPV39/56/66/68-positive), one HPV18/45-positive, and one HPV16-positive (plus an unknown genotype). No statistically significant relationship existed between genotype and visual inspection with acetic acid outcome. This study highlights the high prevalence of non-16/18 hrHPV and the need for extended genotyping to manage women at risk for cervical cancer in Uganda. It calls for more research on the possible role of HPV31/33/35/52/58 in the carcinogenesis of cervical cancer and whether the available vaccines are protective of this population. https://clinicaltrials.gov/study/NCT05234112 .