HPV Risk Factors Research Articles

Monitoring HPV Prevalence and Risk Cofactors for Abnormal Cytology in the Post-Vaccination Period among Croatian Women.

The incidence and mortality rate of cervical cancer in Croatia remains a health challenge despite screening efforts. Besides the persistent infection with HPV, the development of cancer is also associated with some cofactors. The goal of this study was to assess circulating HPV genotypes and risk factors for the development of cervical precancer after almost 16 years from the onset of HPV vaccination in Croatia. In this study, a total of 321 women attending gynecological care were evaluated. Relevant medical and demographic information, including cytology, were collected. HPV genotyping was performed by PCR. Comparing the HPV types found in circulation in the pre-vaccination (1999-2015) and post-vaccination periods (2020-2023), a statistically significant reduction in HPV 31 was noted, while the overall prevalence increased in the post-vaccination period. Besides the expected HPV positivity as a risk factor, the history of smoking was associated with LSIL or worse cytology at enrollment. For the first time, this population study revealed a statistically significant shift in the HPV genotype in the post-vaccination period, as well as the confirmation of risk factors for the development of abnormal cytology among Croatian women.

HPV Positive Women and Risk Factors in Development Cervical Intraepithelial Lesions

Background: Human papillomavirus is a risk factor in the development of cervical cancer. Other risk factors are frequent vaginal infections, cigarette smoking, use of oral contraceptives, but also lack of lacrobacillus in women with HPV infection. Objective: The objective of our study was to determine the risk factors for the development of cervical intraepithelial lesions in women with normal and pathological Pap test results. Methods: The research is a prospective study conducted in the Gynecology Center "Dr. Mahira Jahić" Tuzla and Dom Zdravlja Tešanj since February. 2023 to March 2024. The research included 200 respondents aged 25 to 50. Tested group: 100 subjects with pathological Pap smear findings (ASCUS, LSIL and HSIL) and a control group of 100 subjects with normal Pap smear findings. Sociodemographic data were obtained from the subjects during interviews and examinations: age, cigarette consumption and frequency of previous vaginal infections and the presence of lactobacilli. The obtained results were processed using the methods of descriptive statistics, student's t test and X2 test. A difference for a value of p<0.5 was considered statistically significant. Results: The mean age of the dpbo examined group was 38.1±1.7, while in the control group it was 39.6±1.9 years. Cigarettes were consumed by 62 (31%), 38 (19%) of the examined group, and 24 (12%) of the control group with a statistically significant difference of p<0.05. Out of a total of 100 in the examined group, 60 subjects had LSIL, 9 subjects had HSIL (CIN 2 two subjects and CIN 3 had 7), and ASCUS 29 and ASC-H 2 subjects. Subjects with pathological findings had significantly more vaginal infections during one year (p<0.05). HPV was positive in 65 (65%) subjects with a pathological Pap smear test, and negative HPV in 35 (35%). HPV 16,18 was present in 19 (19%) test subjects in combined form, and mono-isolate HPV 16 in 14 (14%) and HPV 18 in one case. In the combined form of several HPVs, HPV 16 and HPV 31, 33, 35, 45, 56 were found in 5 (5%), and HPV 18 in 4 (4%) with HPV 36, 59, 68. The most frequently isolated HPV 16 in 38 (38%) as monoisolate and in combined form. Lactobacilli were present in 26 (13%) subjects in the test group and in 60 (30%) subjects in the control group, with a statistically significant difference (p<0.05). The presence of Lactobacillus in subjects with a regular Pap test is significantly more frequent compared to women with cervical intraepithelial lesions (ASCUS, LSIL, ASC-H and HSIL) ) in the finding of the Pap test. Conclusion: Altered microflora of the vagina, lack of lactobacilli, frequent vaginal infections and smoking are risk factors for the development of CIN lesions in women positive for high-risk HPV.

Molecular study of the presence and transcriptional activity of HPV in semen

PurposeHuman Papillomavirus (HPV) in semen represents a controversial topic. Recent evidence suggests a correlation with poor semen quality, but its detection is still unstandardized in this biological fluid. Thus, the aims of this study were to verify the ability of nested PCR to reveal HPV-DNA in semen; to evaluate association of seminal HPV with sperm parameters and risk factors for infection; to investigate the rate of HPV-DNA positivity in patients with and without risk factors; to assess HPV transcriptional activity.MethodsWe enrolled sexually active men and collected clinical and anamnestic data during andrological and sexually transmitted infections (STIs) evaluation. For each patient, we performed semen analysis and nested PCR to detect HPV-DNA in semen. In positive semen samples, we proceeded with genotyping and RNA quantification to detect HPV transcriptional activity.ResultsWe enrolled 185 men (36.0 ± 8.3 years), of which 85 with (Group A) and 100 without HPV risk factors (Group B). Nested PCR was able to reveal HPV-DNA in semen, discovering a prevalence of 8.6% (11.8% in Group A and 6% in Group B, respectively). We observed no correlation between sperm quality and seminal HPV. Genital warts and previous anogenital infection were significantly associated with the risk of HPV positivity in semen. Moreover, no viral transcriptional activity was detected in positive semen samples.ConclusionsOur study suggests that searching for seminal HPV could be important in patients both with and without risk factors, especially in assisted reproduction where the risk of injecting sperm carrying HPV-DNA is possible.

HPV frequency, p16 expression and risk factors for oral leukoplakia from Córdoba, Argentina

Background: Non-homogeneous results about the frequency of HPV in leukoplakia are presented in current literature, possibly linked to different factors. Among them, a diverse HPV geographical distribution was suggested. This study aimed to describe the frequency of HPV in patients diagnosed with leukoplakia. Patients & Methods: A cross-sectional study was carried out at the Facultad de Odontología, Universidad Nacional de Córdoba. HPV status was studied by polymerase-chain reaction (HPV-PCR) and p16 by immunohistochemistry. HPV status was analyzed concerning the clinical-demographic features using the Fisher test and the McNemar test. Results: There were included 33 patients diagnosed with different subtypes of oral leukoplakia. HPV genome was detected by PCR in 48.5% (n=16). The most common viral genotype was HPV16. p16 was positive in 27% (n=9) of the cases. The concordance between HPV detection techniques showed poor or weak agreement (Mc Nemar 0.1185). Except for chronic mechanical irritation with HPV-PCR + (p=0.0049), and tongue location with HPV-PCR + (p=0.0366), no significant statistical association between the other included variables was found. Conclusions: The low frequency of HPV in this study agrees with previous studies of our region. Chronic mechanical irritation could play a role in the development of HPV-associated leukoplakias, mainly located on the ventrolateral tongue.

Genotype distribution of cervical HPV among Caribbean women in a population-based study in Martinique: The DEPIPAPUFR study.

The Caribbean ranks seventh among the world regions most affected by cervical cancer. HPV-prevalence and genotype distributions also differ from regions. Knowledge of HPV genotype profiles is important for patients care and HPV vaccination implementation. The objective of this study was to describe HPV genotype distribution and risk factors in a population-based cohort of women in Martinique. In this study, 1312 women were included and underwent cervical cancer screening with successful sample collection between 2009 and 2014. Sociodemographic and clinical variables were recorded. Cytological examination of cervical vaginal smear was performed and classified(Bethesda). Detection of HPV DNA was performed with the PapilloCheck© Kit from Greiner Bio-one. Genotypes were analyzed for18 high-risk HPV (hrHPV) and 6low-risk HPV(lrHPV) types. A total of 1075 women were included with a mean age of 49.1±10.5 years. HPV prevalence was 27.6% (297/1075) with 19.4% (209/1075) women with only hrHPV, 5.3% (57/1075) with only lrHPV. Multiple infections (hrHPV/lrHPV) were detected in 31/240 cases of hrHPV (12.9%). A total of 353 hrHPV genotypes were analyzed; the most common HPV types were HPV51 (11.0%), HPV68 (10.8%), HPV53 (9.1%) and HPV 52 (7.1%). HPV16 and HPV18 represented respectively 4.8% and 4.0% of hrHPV genotypes. Abnormal cytology was observed in 34 cases (3.2%), with 14 ASCUS (1.3%), 10 LSIL (0.9%), 5 HSIL (0.5%), 3 ASC-H (0.3%) and 2 AGC (0.2%). Fifteen (44.1%) were hrHPV and 4 (14.7%) lrHPV; 7 cases of hrPHV were in the age-group 25–34 years. Among 1041cases of normal cytology, 225 had positive hrHPV detection (21.6%). This is the first population-based study of HPV profiles in our country, and we found a high prevalence of hrHPV. The most common genotypes were HPV51, 68, 53. These results could serve for cancer vaccination strategies and HPV surveillance in Martinique.

Abstract D028: Evaluating medical and dental students’ human papillomavirus-related cancer knowledge and perceived self-efficacy in HPV vaccine communication and recommendation practices

Abstract Introduction: Medical and dental care are largely siloed, making it difficult for these culturally, financially, and educationally different health care professionals to work together to provide comprehensive care. Engaging dentists in HPV-related prevention activities may be a meaningful strategy to reduce HPV-related morbidity and mortality. Therefore, effective prevention strategies coupled with systems-level strategies could improve interprofessional approaches in HPV prevention. We sought to assess HPV health literacy and intended HPV vaccination recommendation and communication practices among future health care providers. Methods: A 31-item survey for dental students and 25-item survey for medical students assessing HPV and HPV vaccine knowledge, willingness to administer HPV vaccines, self-efficacy in engaging in preventive efforts, and basic demographics was administered to students from a southeast School of Dental Medicine and School of Medicine. Surveys were administered in Spring 2018 for dental students (N=109) and Spring 2019 for medical students (N=105). Results: Dental students’ sample was 61% female, mean age of 25.79 (SD=3.31), 61% white, 48% 1st year and 52% 3rd year. Medical students’ sample was 51% female, mean age of 25.18 (SD=3.31), 58% white, 71% 1st year and 29% 2nd-4th year. Among our sample, 62% of dental students self-reported receiving the HPV vaccine (30% completion rate) and 56% of medical self-reported being vaccinated (22% completion rate). The majority (67%) of dental and medical students did not know most HPV infections clear up on their own within 2 years and that HPV-related OPC is higher among men as compared to women (66% of dental; 78% of medical students). In regards to vaccine knowledge, 54% of dental students were not aware of the recommended 2-dose administration and 45% of medical students were not aware of vaccine recommendations for gay, bisexual, and other men who have sex with men, transgender people, and for immunocompromised persons. When asked about perceived self-efficacy in engaging in HPV preventive efforts, 42% of dental students anticipated having an uncomfortable conversation with patients when recommending the HPV vaccine, 43% did not feel confident in performing oral cancer exams, 56% did not feel confident in recommending the HPV vaccine, and 66% did not feel confident in talking about HPV risk factors. Among medical students, 27% anticipated having an uncomfortable conversation with patients when recommending the HPV vaccine, 29% did not feel confident in recommending the HPV vaccine, and 37% did not feel confident in talking to patients about HPV risk factors. Final analysis will be presented at conference. Conclusion: This study can improve our preliminary understanding of interprofessional training opportunities for effective systems-level strategies to improve bidirectional access and communication across oral health and primary care to engage in effective HPV prevention across professions. Citation Format: Essie Torres, Alice Richman, Wanda Wright, David Eldridge, Luan Lawson. Evaluating medical and dental students’ human papillomavirus-related cancer knowledge and perceived self-efficacy in HPV vaccine communication and recommendation practices [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D028.

2531. Using Peer-to-Peer Education to Increase Awareness and Uptake of HPV Vaccine Among Chinese International Students

BackgroundThere are more than one million international college students in the United States. The University of Southern California hosts about 5,000 Chinese International Students (CIS). HPV-related cancers are common in China and the HPV vaccine was only recently introduced to the Chinese population. CIS in the United States have low HPV vaccination rates upon arrival. Once these students become aware of the affordability and the accessibility of the vaccine, they often contact a provider to start the vaccination series. The HPV vaccine is available to all eligible students at the USC student health center and is free of charge to students with Aetna Student Health Insurance. We examined the impact of a peer-to-peer education program about HPV disease and vaccination amongst CIS and assessed the impact of the program via an analysis of HPV immunization rates amongst CIS.MethodsThe study was IRB approved. Mandarin-speaking USC students volunteered to serve as peer educators in response to an inquiry from academic advisors. 18 CIS were trained by MiOra as Immunization Community Health Educators (ICHE) on HPV disease and vaccination as well as sexually transmitted infections and prevention. CIS educated peers at tables set up throughout USC.ResultsInitial data from 100 CIS students who were surveyed and educated in April 2019 were analyzed. 59 out of 99 (59.6%) students reported that they have either received or are in the process of receiving the HPV vaccine. 93 out of 99 (93.9%) indicated “no knowledge” or “some knowledge” about HPV and HPV vaccine while only 6 students (6.1%) reported “a great deal of knowledge.” 56 out of 99 (56.6%) thought that it is “unlikely” or “impossible” for them to acquire HPV. 92 out of 97 (94.9%) said they would be interested in getting vaccinated if it were free.ConclusionMany CIS have limited understanding of HPV risk factors and HPV vaccine; however, when informed, the majority of students indicated they would likely vaccinate if it was covered by insurance. Peer-to-peer education was very effective. Of the first 400 students educated, 80 visited the student health center. This is an ongoing project. We will continue to collect and report data on the impact of the peer-to-peer education and factors influencing.Disclosures All authors: No reported disclosures.

044 Epidemiology of HPV Risk Factors and Birth Control Methods Between HPV Positive and HPV Negative Women in Rural Arkansas

044 Epidemiology of HPV Risk Factors and Birth Control Methods Between HPV Positive and HPV Negative Women in Rural Arkansas

Abstract B13: New messages and opportunities for prevention to empower African American women through community-based outreach and education on breast and cervical cancer risk

Abstract Purpose of the Study: Historically, African American women have suffered from breast cancer less but died more often than other racial and ethnic minority groups. New data show that the gap in incidence is closing, with African American women now being diagnosed more frequently than previously recognized, while still having much higher death rates. Additionally, new scientific research now clearly demonstrates that having more children, at earlier ages (formerly linked to lower risk), and not breastfeeding actually increases risks of aggressive, triple-negative breast cancer in African American women. This important paradigm shift is not currently being disseminated in the lay community. Over the past 20 years, The National Witness Project (NWP) has been implemented, replicated, and disseminated in more than 40 sites across 22 states, with over 400 volunteers, reaching over 15,000 women annually, and increasing mammography as much as 43%. Using this well-established network, we implemented a community-engaged approach to revise and pilot both the community-based training and education program content to reflect current scientific findings and trend data. Methods: Three pilot sites for testing the new community-based education were selected: the established NWP sites in Buffalo, New York City, and Arkansas. Health education staff and volunteers at each of the sites were trained to deliver the new program, which includes information on the following topics: breast cancer risk factors including new information on breastfeeding and parity, genetic risk, myths, mammography-screening guidelines, breast health awareness, role-model video stories for breast and cervical cancer, HPV risk factors and causes, modes of virus transmission, HPV vaccine, and Pap test. Additional video segments featuring community partners sharing their personal experiences were also included to further enhance the educational content. Educational programs implemented an Audience Response System (ARS) to test pre- and post-items related to breast and cervical cancer risk, myths, self-efficacy to screen, and intent to screen. Scores from the pre- and post-knowledge tests were computed as the average percent correct of the responses to each question and were compared across all participants and by site. Comparisons of pre-post test scores were made using paired-sample t-tests. Results: A total of 332 participants were reached during 31 programs across all three sites. Age ranges of the African American women who participated were 19 to 102 years old with a mean age of 51 years. We found 44% of participants answered 55% of all questions correctly prior to the program and at post-test answered 92% correctly (p > 0.000). For breast-cancer items only, 53% of participants answered 48% of pre-test questions correctly compared to 75% correctly at post (p > 0.000). Similarly, 57% of participants answered 46% of pre-test cervical cancer items correctly and 78% correctly at post (p > 0.000). For the items pertaining to new information on breastfeeding, parity, and HPV virus transmission and vaccination, 57% of participants answered 32% of pre-test questions correctly and answered 78% correctly on the post (p = 0.000). Conclusions: The increases shown from pre- to post-test across all three sites and across topics demonstrate effectiveness of the intervention to educate underserved African American women on current (or up-to-date) breast and cervical cancer health information. This pilot study also provided insight on areas for improvement with respect to identifying and addressing critical implementation barriers. Additionally, the new programmatic content expands the age to include younger women in outreach and highlights the need to assess both the psychological and behavioral impacts across African American women of all ages. Next steps will include examining our ability to implement and disseminate the new program through the NWP network of 14 active sites. Citation Format: Elisa M. Rodriguez, Frances G. Saad-Harfouche, Christy A. Widman, Clark S. Nikia, Clarissa Martinez, Detric Johnson, Lina Jandorf, Deborah Erwin. New messages and opportunities for prevention to empower African American women through community-based outreach and education on breast and cervical cancer risk [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B13.

HPV Risk Factors and Prevention Behaviours: A Review

HPV Risk Factors and Prevention Behaviours: A Review

Prevalence of anogenital HPV infection, related disease and risk factors among HIV-infected men in inner-city Johannesburg, South Africa: baseline findings from a cohort study

BackgroundPersistent high-risk human papillomavirus (HR-HPV) infection is associated with the development of anogenital cancers, particularly in men living with HIV (MLWH). We describe the prevalence of anogenital HPV infection, abnormal anal cytology and anogenital warts (AGWs) in MLWH in Johannesburg, and explore whether HPV infection and receipt of antiretroviral treatment is associated with detection of abnormal anal cytology and AGWs.MethodsWe enrolled a cohort of 304 sexually-active MLWH ≥18 years, who completed a questionnaire and physical examination. Genital swabs were collected from all men and intra-anal swabs from 250 (82%). Swabs were tested for HPV DNA and genotypes, and anal smears graded using the Bethesda classification. Factors associated with anogenital disease were assessed by logistic regression models.ResultsTwo thirds were receiving antiretroviral treatment, for a median 33 months (IQR = 15–58) and 54% were HIV-virologically suppressed. Only 5% reported ever having sex with men. Among 283 genital swabs with valid results, 79% had any HPV, 52% had HR-HPV and 27% had >1 HR-HPV infection. By comparison, 39% of the 227 valid intra-anal swabs had detectable HPV, 25% had any HR-HPV and 7% >1 HR infection. While most anal smears were normal (51%), 20% had ASCUS and 29% were LSIL. No cases had HSIL or cancer. Infection with >1 HR type (adjusted OR [aOR] = 2.39; 95%CI = 1.02–5.58) and alpha-9 types (aOR = 3.98; 95%CI = 1.42–11.16) were associated with having abnormal cytology. Prevalence of AGWs was 12%. Infection with any LR type (aOR = 41.28; 95%CI = 13.57–125.62), >1 LR type (aOR = 4.14; 95%CI = 1.60–10.69), being <6 months on antiretroviral treatment (aOR = 6.90; 95%CI = 1.63–29.20) and having a CD4+ count <200 cells/μL (aOR = 5.48; 95%CI: 1.60–18.78) were associated with having AGWs.ConclusionsIn this population, anogenital HR-HPV infection and associated low-grade disease is common, but severe anal dysplasia was not detected. Findings reinforce the need for HPV vaccination in men for preventing both AGWs and HR-HPV infection. Given the absence of anal HSILs, however, the findings do not support the use of anal screening programmes in this population.

A Pilot Study on the Knowledge of HPV Infection and Risk Factors among Mexican Undergraduate Students

A Pilot Study on the Knowledge of HPV Infection and Risk Factors among Mexican Undergraduate Students

Abstract 1430: Do race and gender independently predict risk factors associated with the Human papillomavirus

Abstract Purpose To assess racial and gender differences, among a drag racing population, as predictors of sexual risk factors associated with HPV infection, including number of oral sexual partners, age of first vaginal sex, and age of first oral sex. Methods A cross-sectional study was conducted at a drag racing event on September 12-13, 2015 in Madison, Illinois. Independent variables were gender and race. Outcome variables were number of oral sexual partners (high vs. low), age of first vaginal sex, and age at first oral sex. Multivariable logistic regression was used to examine the association between race and gender, and number of sexual partners. Multivariable linear regression analysis assessed the association between race and gender, and age of first vaginal sex, and age at first oral sex. Results Three hundred and one individuals took our survey. Of these respondents, 63% were male, and 65% identified as African Americans. Mean age for this population was 48 ± 13 years. Approximately 45% of participants reported they have had four or more oral sexual partners. Mean age for first vaginal sex was 17 ± 3 years, 20 ± 6 years for first oral sex. Multivariate logistic regression revealed that gender was a significant predictor of number of oral sexual partners, but race was not significant. Men compared to women were more likely to have a high number of oral sexual partners (OR = 2.08; 95% CI: 1.23, 3.57). In multivariable linear regression, gender and race were significant predictors of age of first vaginal sex, and age at first oral sex. Men were more likely to have earlier vaginal sexual debut as compared to women (β = -1.13; 95% CI: -1.82, -0.43) as were African Americans compared to Caucasians (β = -1.14; 95% CI: -1.82, -0.46). Men were also more likely to have earlier oral sexual debut as compared to women (β = -2.51; 95% CI: -3.98, -1.04). Caucasians were more likely to have earlier oral sexual debut as compared to African Americans (β = 2.44; 95% CI: 1.02, 3.87). Conclusions Race and gender were independent predictors of HPV risk factors. Males were more likely to initiate earlier and engage in both oral and vaginal sexual behaviors that are high risk for developing HPV. Caucasians were more likely to initiate earlier, and engage in oral sexual behaviors that are high risk for developing HPV. These findings provide impetus for the development of targeted educational interventions aimed at improving knowledge of these sexual risk factors among Caucasians and males, in the community. Citation Format: Rebecca L. Rohde, Nosayaba Osazuwa-Peters, Eric Adjei Boakye, Rajan Ganesh, Ammar Moiyadi, Adnan S. Hussaini, Mark A. Varvares. Do race and gender independently predict risk factors associated with the Human papillomavirus. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1430.

HPV vaccination: acceptance and influencing factors among young men in Germany.

This study aims to determine the factors that influence the acceptance of the HPV vaccination among German males. In 2014, we conducted a population-based cross-sectional study in men aged 15-25 years. A questionnaire was mailed to male trainees of the Bayerische Motorenwerke AG (BMW) insured at the BMW health insurance company. The response rate was 10.8%. Of the 378 included men, 74.1% would agree to receive HPV vaccination. Most men primarily consult their physician for health-related topics, but 92.9% had never been informed about HPV infection, risk factors and prevention methods by their doctor. Our results demonstrate a high acceptance of male HPV vaccination. Education about HPV infection is low and should be intensified by medical professionals.

Racial and ethnic differences in human papillomavirus positivity and risk factors among low-income women in Federally Qualified Health Centers in the United States

Reasons for racial/ethnic disparities in HPV infection are unclear. This study assessed racial/ethnic differences in and risk factors for HPV positivity among low-income women. Data were collected from 984 low-income women visiting Federally Qualified Health Centers across Illinois (2009–2011). Pearson chi square and Logistic regression analyses were used to examine associations with HPV positivity. Our results showed Mexican-born Hispanics had the lowest HPV positivity (16%), followed by non-Hispanic whites (29%), US-born Hispanics (35%), and non-Hispanic blacks (39%). Mexican-born Hispanics reported fewer risk behaviors for HPV positivity, including first sexual intercourse before age 16years (9% versus 27%), multiple sexual partners in lifetime (48% versus 90%), and current cigarette smoking status (10% versus 35%) when compared to non-Hispanic whites (p<0.001). In multivariate-adjusted logistic regression, being non-Hispanic black, first sexual intercourse before age 16years, increasing numbers of recent or lifetime sexual partners and current cigarette smoking status were associated with a higher likelihood of HPV positivity. Our findings highlight racial/ethnic differences in HPV positivity and risk factors in a population of women with similar socioeconomic characteristics. When measuring HPV risk factors within the Hispanic population, foreign-born status and other mediating factors, such as social norms and cultural characteristics, may be relevant to assess the intragroup heterogeneity.

Acceptability of self-collected versus provider-collected sampling for HPV DNA testing among women in rural El Salvador

ObjectiveTo determine the acceptability of self-collected versus provider-collected sampling among women participating in public sector HPV-based cervical cancer screening in El Salvador. MethodsTwo thousand women aged 30–49years underwent self-collected and provider-collected sampling with careHPV between October 2012 and March 2013 (Qiagen, Gaithersburg, MD, USA). After sample collection, a random sample of women (n=518) were asked about their experience. Participants were questioned regarding sampling method preference, previous cervical cancer screening, HPV and cervical cancer knowledge, HPV risk factors, and demographic information. ResultsAll 518 women approached to participate in this questionnaire study agreed and were enrolled, 27.8% (142 of 511 responding) of whom had not received cervical cancer screening within the past 3years and were considered under-screened. Overall, 38.8% (n=201) preferred self-collection and 31.9% (n=165) preferred provider collection. Self-collection preference was associated with prior tubal ligation, HPV knowledge, future self-sampling preference, and future home-screening preference (P<0.05). Reasons for self-collection preference included privacy/embarrassment, ease, and less pain; reasons cited for provider-collection preference were result accuracy and provider knowledge/experience. ConclusionSelf-sampling was found to be acceptable, therefore screening programs could consider offering this option either in the clinic or at home. Self-sampling at home may increase coverage in low-resource countries and reduce the burden that screening places upon clinical infrastructure.

HPV infection, risk factors and viral load among Mexican male college students

ObjectivesTo determine the prevalence of HPV and the risky sexual behaviors associated to it in a sample of male college students, taking into account genotype and viral load. MethodsFrom 2002 to 2003, male students from the Autonomous University of Morelos State completed a questionnaire and provided self-collected genital samples to detect and quantify HPV. We performed a bivariate and a multivariate logistic regression analysis to identify correlates associated with the infection and to assess the viral load as a function of the viral infecting type. The fragments of β-globin gene and L1 of HPV, were amplified, purified and cloned, to evaluate viral load. ResultsAmong 253 subjects, HPV prevalence was 19.4%, and HPV16 was the most common subtype. History of STIs (OR=4.8; 95% CI 1.2–18.9), contraceptive pill use by female partner (OR=2.6; 95% CI 1.1–6.3) and exchanging sex for money (OR=4.9; 95% CI 1.2–20) were associated to the HPV infection. HPV16 viral load was 7.8 copies (HPV/beta-globin) compared to 0.9 copies for other HPV types. DiscussionHPV16 displayed the highest viral load, and it was the most prevalent. It was found that using contraceptive pills by female partners was associated with HPV infection.

Using risk to target HPV vaccines in high-risk, low-resource organizations

Organizations in developed countries with limited financial resources may find it difficult to determine whether it is preferable to use these resources for HPV vaccination, management of HPV-related diseases, or a “hybrid” strategy, such as vaccinating only the highest risk individuals. We determined the organizational costs and clinical impacts of three different organizational approaches to female HPV vaccination in a low-resource setting, including vaccinating everyone, vaccinating no one, or vaccinating only those considered high-risk. To determine patients at highest risk, HPV risk factors were identified using information routinely gathered at the annual preventive maintenance visit. The three vaccination strategies were then compared using a decision tree analysis. The three strategies demonstrated very little difference in cost. However, the least expensive strategy was to vaccinate no one. In contrast, the strategy with the best clinical outcomes was for the organization to vaccinate everyone. Organizations with limited resources must decide how to best allocate these funds to provide the greatest clinical benefits. This study showed little difference in costs but improved clinical outcomes when using the universal HPV vaccination strategy. Thus, the improvement in clinical outcomes when vaccinating everyone may be worth the relatively small increase in cost of vaccinating everyone.

Prevalence, incidence and persistence of genital HPV infections in a large cohort of sexually active young women in the Netherlands

BackgroundWe assessed age- and type-specific HPV prevalence, incidence and persistence and their associated risk factors in young women prior to vaccination, to enable monitoring of the impact of introduction of HPV vaccination in the years before participation in the cervical screening program. MethodsThe HPV status was assessed in 3282 women aged 16–29 who participated in a Chlamydia trachomatis screening implementation program, of which 2014 women (61%) participated in two rounds (one year apart). Self-collected vaginal swab were analyzed by SPF10 LiPA on the presence of HPV DNA. Risk factors for prevalent, incident and persistent HPV infections were calculated using generalized estimating equation. ResultsThe prevalence of any HPV in the first round amounted to 54%, while 34% of the women who participated in the second round had a persistent infection and 45% an incident infection. The five most common HPV types found in this study were HPV16, −51, −52, −31 and −53. HPV16 and/or HPV18 prevalence, incidence and persistence in the second round were 15%, 8% and 9%, respectively and for HPV6 and/or HPV11 6%, 4% and 2%, respectively. Relatively to other HPV genotypes, hrHPV types were found more often as a persistent infection than as an incident infection. Furthermore, there is an age-dependent increase within this age range for persistent infections but not for incident infections. ConclusionThe HPV prevalence (54%), incidence (45%) and persistence (34%) is high among sexually active young women in the Netherlands. The different HPV type distribution and risk factors for prevalent, incident and persistent infections, as well as the observed age-trends should be taken into account in interpreting data obtained after vaccine introduction. Repeating measurements post-immunization are particularly relevant until the age when screening starts (i.e. 30 years in the Netherlands).

Abstract B86: HIV and HPV risk and prevention factors among Tongan and Chamorro young adults in Southern California: A qualitative assessment

Abstract Background: Racial/ethnic minority and medically underserved populations are at significant risk of the intersection of HIV/AIDS, HPV, and cancer. Little is known about the intersection of these public health issues in Pacific Islander communities. Purpose: Establishing the ground work for understanding the intersection of these diseases, we assessed HIV and HPV risk and prevention factors among Chamorro and Tongan young adults in Southern California. Methods: Under guidelines of CBPR, a qualitative study was implemented utilizing community based focus groups with male and female young adults, and parents (n=69); and key informant interviews with medical, mental health, and social service providers, and community leaders from social, youth, and faith-based groups (n=26). Results: Utilizing grounded theory, common factors impacting HIV-HPV risk and prevention among young adults were identified: 1) religio-cultural taboos limit communication about sexual health between generations and from community leaders; 2) limited knowledge of HIV and particularly HPV engender misperceptions about disease transmission and prevention; 3) sexual abstinence, especially for young women, is promoted by parents and religious leaders; however, 4) the norm of expected abstinence leads to low levels of condom acceptance; and 5) collectivist notions of filial shame associated with HIV-HPV testing and utilization of other sexual health services, constrains prevention. Discussion: Quantitative exploration of the relationship between factors identified and behavior, as well as research to identify HIV/HPV links to cancer in these communities is needed. Future consideration must include multigenerational, gender appropriate and cultural norms –especially related to religion and the interplay between individualism and collectivism. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B86.