Differential age-related patterns of Human Papillomavirus infection among women in Western Province, Zambia

Human papillomavirus (HPV) infection remains a major global public health concern and is the leading cause of cervical cancer, particularly in low- and middle-income countries. Zambia has one of the highest cervical cancer burdens worldwide, yet evidence on age-specific determinants of HPV infection remains limited. This study assessed the prevalence and determinants of HPV infection among women aged ≤40 years and ≥41 years in Western Province, Zambia. A cross-sectional study was conducted between October 2025 and January 2026 among women attending cervical cancer screening clinics in Western Province. A total of 1,132 participants were recruited using consecutive sampling. Sociodemographic, behavioural, and reproductive data were collected using structured questionnaires. Exfoliated cervical samples were collected and tested for high-risk HPV genotypes using the Hologic Panther platform with transcription-mediated amplification (TMA). Mixed-effects logistic regression was used to identify factors associated with HPV infection while accounting for clustering at the health facility level. Overall, HPV prevalence was 33.6%. HPV prevalence was comparable between women aged ≤40 years and those aged ≥41 years (33.6% vs. 33.4%). Among women aged ≤40 years, multiple lifetime sexual partners, high parity, lack of HPV vaccination, contraceptive use, low income, single marital status, and rural facility location were independently associated with HPV infection (P < 0.05). Among women aged ≥41 years, high parity, low HPV knowledge, unemployment, low income, and geographic location were independently associated with HPV infection (P < 0.05). Spatial variation was also observed, with significantly higher infection rates in Mwandi district. HPV infection remains highly prevalent across, in both younger and older women. Although the determinants differ by age group, the substantial HIV burden and ongoing HIV transmission may contribute to the persistence of HPV infection. These findings support age-specific prevention strategies that integrate HPV vaccination, cervical cancer screening, health education and treatment services to reduce the burden of HPV infection.