Ashrafun Nessa

High-risk human papillomavirus genotypes among women of hill districts in Bangladesh

Knowledge on the distribution of type specific HPV (Human papillomavirus) genotypes in female cervix is crucial to identify women who are at a higher risk of developing cancer. This study aimed to find out the prevalence of High-risk HPV genotypes among women of three Hill districts of Bangladesh. This cross-sectional study was conducted between 1st January and 30th June 2024 among 1602 selected married asymptomatic tribal and nontribal women (30–60 years of age) at three Hill districts. Partial genotyping of HPV DNA specimens which detects the presence of 14 high-risk genotypes (including individual HPV-16, HPV-18, and others as a pooled group) was performed at Bangladesh Medical University (BMU). Women with previous treatment of cervical precancer and cancer, hysterectomy, cervical amputation and pregnancy were excluded. Statistical analysis utilized SPSS version 25.0, employing Chi-square and Fisher’s Exact tests and P value <0.05 were considered significant. HR-HPV prevalence’s were expressed as proportions. The influence of HR-HPV infection and socio-demographic factors was assessed using multinomial logistic regression analysis. The overall HR-HPV prevalence was 2.7% (n = 44) and 0.8% (n = 13) were tested positive for HPV16, 0.2% (n = 4) for HPV18 and 1.6% (n = 26) for ‘Other HR-HPV’ types. No significant difference of HR-HPV prevalence was observed among the three districts (p-value = 0.352) and among tribal (2.4%) and non-tribal/Bengali (3.2%) women (p-value>0.05). Higher number of marriages of the husbands have independent association with HR-HPV positivity showing an odds ratio of 2.02 (95% CI: 1.07–3.82, p = 0.030). The HR-HPV prevalence in hill districts of Bangladesh is low with independent association of higher number of marriages of the husbands with HR-HPV positivity. These findings may guide policymakers to initiate HR-HPV DNA-based screening and reconsider vaccination strategies in the hill areas, including the introduction of gender-neutral vaccination.

Cervical high-risk human papillomavirus infection and its associated risk factors: a community-based cross-sectional study in hard-to-reach areas in Bangladesh

Objectives This study aimed to determine the prevalence of cervical high-risk human papillomavirus (hrHPV) in a community-based setting and its risk factors association in women living in hard-to-reach areas in Bangladesh. Design A cross-sectional study Setting The study was carried out in six subdistricts, located in hard-to-reach and climate-impacted regions of Bangladesh. Participants A total of 8000 married women aged 30–60 years were invited for screening. Women who were unable to give consent, were pregnant or had a hysterectomy with removal of the cervix, previous screening less than 5 years, or treatment of the cervix or had symptoms of potential cervical cancer were excluded. Interventions A community-based hrHPV self-collected screening for cervical cancer was conducted from June 2022 to July 2023. Main outcome measures Prevalence of cervical hrHPV and risk factor association. Results 11 127 women were eligible for screening; 7850 women submitted hrHPV self-swabs, 7828 valid HPV test results were reported and 164 women (2.1%) tested hrHPV positive. Women living in the North were 2.1 times more likely to be hrHPV positive compared with women living in the South (adjusted OR (AOR)=2.1, 95% CI: 1.5 to 3.8, p=0.023) and widowed women were 3.0 times more likely to be hrHPV positive than married women (AOR=3.0, 95% CI: 1.7 to 5.3, p=0.001). Another risk factor associated with testing hrHPV positive was the use of hormonal contraceptives for 5 years and above (AOR=7.0, 95% CI: 2.0 to 24.4, p=0.002). Conclusion The study identified a low overall prevalence of hrHPV infection (2.1%) among women in hard-to-reach areas in Bangladesh, with some regional variations. Higher prevalence was observed in widowed compared with married women and among women reporting more than 5 years of hormonal contraceptive use. This study shows no evidence of particularly high-risk groups in hard-to-reach areas in Bangladesh. The findings support the feasibility of implementing a nationwide hr-HPV-based self-sampling strategy as a viable approach to reach WHO targets for reducing the burden of cervical cancer. Recommendation for policymakers to support future research to identify hrHPV prevalence among women in comparable groups in other geographically remote areas in Bangladesh. Trial registration number NCT05234112 .