Abstract
Implementation of Human Papillomavirus (HPV) vaccination should be considered a key cervical cancer prevention strategy in Tunisia, where Pap smear screening is not efficient. This study aims to estimate the prevalence and to identify risk factors associated with HPV infection among women from Grand Tunis, Tunisia. We conducted a cross-sectional study, between December 2012 and May 2013. Eligible women for this study were those aged 18–65 years, sexually active, who sought medical attention at their primary health care centre or clinic in Grand Tunis, Tunisia and who gave written consent. A liquid-based Pap smear sample was obtained from all women using a cervical brush. Only women with betaglobin positive test were further analysed for HPV detection and typing. A nested-PCR of the L1 region was performed followed by reverse line blot hybridization to facilitate the specific detection of 31 HPV genotypes. Multiple logistic regression modeling was used for the analysis of associations between variables with some considered possible confounders after checking for interactions. A total of 391 women were enrolled in this study and 325 out of the 391 cervical samples were positive for the betaglobin test. Overall HPV prevalence was 13.2% [9.8%−17.5%], with the following most prevalent HPV genotypes: HPV6 (40%), HPV40 (14%), HPV16 (12%), HPV52 (9%), HPV31 and HPV59 (7%), followed by HPV68 (4%). Mean age of HPV positive women was 40.7±0.92 years. Independently associated risk factors of HPV infection were smoking (OR:2.8 [0.8–9.6]), low income (OR:9.6 [1.4–63.4), bad housing type (OR:2.5 [1–6.8]), partner with multiple sexual relationship (OR:4.5 [0.9–22.9]) and single women (widowed, divorced, separated, never married) (OR:6.9 [1.1–42.2]). This study provides the first national-based estimate of HPV prevalence in Tunisia. Our findings contribute to the evidence on the current burden of HPV infection, the critical role of sexual behaviour and socioeconomic status and call for increased support for the screening program in Tunisia to prevent cervical cancer. These results allow us to evaluate the cost-effectiveness of vaccine program implementation in Tunisia in future.
Highlights
Human Papillomavirus (HPV) is the most common cause of sexually transmitted diseases and causes a wide range of pathologies [1, 2]
A total of 27 (8.3%) cervical cytology samples were inadequate. For those with adequate results, Pap smear was normal for 115 women (35.4%, 95% confidence intervals (CI), 33.4%-44.4%). It was atrophic or inflammatory for 141 women (43.4%, 95% CI, 41.9%-52.8%), Low-squamous intraepithelial lesions (LSIL) were seen for 38 women (11.7%, 95% CI, 9.5%-16.7%) and High-squamous intraepithelial lesion (HSIL) and Atypical glandular undetermined significance (AGUS) accounted for two cases (0.6%, 95% CI, 0.2%1.9%)
Baseline information on HPV prevalence and genotype distribution is crucial to evaluate the impact of HPV vaccines and inform the best approach for cervical cancer prevention
Summary
Human Papillomavirus (HPV) is the most common cause of sexually transmitted diseases and causes a wide range of pathologies [1, 2]. In the 1980s, the link between cervical cancer (CC) and HPV was established [5]. Two vaccines are currently available (Bivalent (HPV16/18 and Quadrivalent HPV6/11/16/18) to protect from HR-HPV-16 and 18 with a good safety and efficacy and a cross-protection against other common HR- HPV types [2, 9,10,11]. These vaccines have been widely introduced into the national immunization programs in most medium and high- income countries [2, 12]
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