Abstract
BackgroundCervical cancer is the most common female cancer in Rwanda that, in 2011, became the first African country to implement a national vaccination programme against human papillomavirus (HPV).MethodsTo provide a robust baseline for future evaluations of vaccine effectiveness, cervical cell specimens were obtained from 2508 women aged 18–69 years from the general population in Kigali, Rwanda, during 2013/14. 20 % of women were HIV-positive. Samples were used for liquid-based cytology and HPV testing (44 types) with GP5+/6+ PCR.ResultsHPV prevalence was 34 %, being highest (54 %) in women ≤19 years and decreasing to 20 % at age ≥50. Prevalence of high risk (HR) HPV and cytological abnormalities was 22 and 11 % respectively (including 2 % with high-grade squamous intraepithelial lesions, HSIL) decreasing with age. Age-standardised prevalence of HR HPV was 22 % (or 19 % among HIV-negative women), and HPV16 was the most common type. Prevalence of HPV and cytological abnormalities were significantly higher in HIV-positive than HIV-negative women, and the difference increased with age. Other significant risk factors for HPV positivity in multivariate analyses were high lifetime number of sexual partners, receiving cash for sex, and being a farmer. 40 % of women with HSIL were infected with HPV16/18 and there was no significant difference between HIV-positive and HIV-negative women.ConclusionsThis study confirms Rwanda to be a setting of high prevalence of HPV and cervical disease that is worsened by HIV. These data will serve as a robust baseline for future evaluations of HPV vaccine programme effectiveness.
Highlights
Cervical cancer is the most common female cancer in Rwanda that, in 2011, became the first African country to implement a national vaccination programme against human papillomavirus (HPV)
Four invasive cervical cancers were found in the study population (2 HPV16, 1 HPV33, 1 HPV negative), and two additional invasive cervical cancers among participants without a valid sample for HPV and cytology
We describe the epidemiology of HPV infection in the adult female population of Rwanda soon after the country successfully embarked upon a national programme of HPV vaccination
Summary
Cervical cancer is the most common female cancer in Rwanda that, in 2011, became the first African country to implement a national vaccination programme against human papillomavirus (HPV). Cervical cancer represents by far the most common cancer among females in Rwanda, and has a high age-standardised incidence rate of approximately 42 cases per 100,000 women per year [1] that is typical of many sub-Saharan African countries. In response to this high burden, Rwanda became the first African country to initiate a national vaccination programme against human papillomavirus (HPV), the necessary cause of cervical cancer. The influence of HIV positivity, which is known to be an important determinant of HPV prevalence and may affect the future effectiveness of HPV vaccination, was evaluated
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