Prevalence, HPV Type Categories, and Associated Factors of High-Risk Human Papillomavirus Infection among Women in Mzuzu City, Malawi

Human papillomavirus (HPV) infection is the primary cause of cervical cancer, which remains a major public health challenge in sub-Saharan Africa, particularly in Malawi. Understanding the local distribution of HPV types and their associated risk factors is essential for optimising screening and vaccination strategies. The study aimed to establish the distribution of HPV types circulating among women in Mzuzu, Malawi. This was a cross-sectional retrospective study which included 385 women attending gynecological services at Mzuzu Urban Health Centre, Malawi, between May 2021 and December 2022. Clinical records were reviewed for age, residential location, HIV status, and HPV results. HPV DNA detection and genotyping were performed using the Xpert HPV assay, which identifies HPV 16, HPV 18/45, and a pooled group of 11 other high-risk HPV (HR-HPV) genotypes. Descriptive statistics were used to assess the prevalence of high-risk HPV and its type distribution. The overall prevalence of HR- HPV infection was 42.9%. The predominant types were among the other HR-HPV types (34%), followed by HPV 18/45 (11.7%) and HPV 16 (9.1%). Multiple infections occurred in 26.7% of positive cases, with the most common combination being HPV 18/45 and other HR-HPV types. The highest infection rate was observed among women less than 26 years (55.6%), while Mzuzu South recorded the largest number of HPV-positive cases (49.2%). HPV infection was more frequent among HIV-positive women (51.6%) than HIV-negative women (40%). The study demonstrates a high prevalence and diversity of HR-HPV type categories among women in Mzuzu City, with non-vaccine HR-HPV types predominating and a notable association with HIV infection. These findings emphasise the need for ongoing molecular surveillance and the consideration of broader-spectrum HPV vaccines. Integrating HPV screening into HIV care and prioritising preventive interventions for younger women may substantially reduce the cervical cancer burden in Malawi.