The American Journal of Tropical Medicine and Hygiene

Factors Associated with Human Papillomavirus Vaccination Uptake Among Adolescent Girls in Uganda

ABSTRACT. Human papillomavirus (HPV) vaccination has been shown to reduce the HPV-related cervical cancer burden. The aim for the present study was to investigate the factors associated with the uptake of HPV vaccination among adolescent girls aged 13–18 years seeking health services at a health center in Uganda. This cross-sectional study was conducted at Naguru Teenage Information and Health Center, an adolescent clinic of Kiswa Health Center III in Kampala, Uganda. Information was obtained from 134 adolescent girls aged 13–18 years who were seeking services at the center. Bivariate and multivariable analyses were conducted to identify factors associated with HPV vaccine uptake. The uptake of a single dose of the HPV vaccine was 18.7% (25/134). Factors associated with HPV vaccine uptake included being from an ethnic group such as the Acholi/Lango (adjusted prevalence ratio [aPR] = 0.3; 95% CI: 0.09–0.6), being from an ethnic group such as Basoga (aPR = 0.2; 95% CI: 0.08–0.8), parents’ level of knowledge (aPR = 0.3; 95% CI: 0.1–0.8), perception of HPV vaccine benefits (aPR = 0.3; 95% CI: 0.1–0.9), knowledge of the location of the nearest HPV vaccination site (aPR = 0.3; 95% CI: 0.1–0.8), distance to the healthcare facility (aPR = 0.5; 95% CI: 0.2–0.7), and healthcare worker recommendations (aPR = 0.3; 95% CI: 0.1–0.7). The uptake of the HPV vaccine was low. There is a need to conduct awareness campaigns for parents, adolescents, and the community about the benefits of the HPV vaccine. This will increase HPV vaccine uptake and reduce the burden of cervical cancer in the community.

Prevalence of Human Papillomavirus and Genotype Correlation with Cervical Lesions at the University Teaching Hospital of Kigali

ABSTRACT. Cervical cancer remains a major health problem, especially in low- and middle-income countries (LMICs), with human papillomavirus (HPV) infection serving as the primary precursor. Despite global efforts to combat cervical cancer, including vaccination, a critical knowledge gap persists regarding HPV prevalence, genotype distribution, and their correlation with cervical lesions in LMICs. This study has assessed the prevalence of HPV infection, identified the most common HPV genotypes, and evaluated their correlation with cervical lesions at the University Teaching Hospital of Kigali, Rwanda. A total of 473 women were screened for HPV infection, with further evaluation of cervical lesions in HPV-positive women. The overall HPV prevalence was 74 of 473 (15.6%), with the highest concentration among women aged 41–45 years (29.7%). HPV genotypes 16 and 18 were most prevalent (7.6% each). Cyto-histological examination showed 23.6% cancerous lesions and 37.2% benign lesions in women with HPV-positive results. Women with high-risk HPV (HR-HPV) infections had a 2.67-fold increased risk of developing cancerous lesions compared with those with low-risk HPV infections (95% CI: 1.08–6.58, P = 0.033). Notably, 21.6% of HPV-positive women were also HIV-positive, highlighting the coinfection of these two viruses. In conclusion, this study demonstrates a varied distribution of HPV genotypes among Rwandan women and a significant association between HR-HPV types and cervical lesions. These findings emphasize the need for tailored cervical cancer prevention strategies, including targeted surveillance, vaccination, and enhanced screening in Rwanda and similar resource-limited settings.

Gut Helminth Infection-Induced Immunotolerance and Consequences for Human Papillomavirus Persistence

ABSTRACT. Cervical cancer, a malignancy caused by persistent human papillomavirus (HPV) infection, develops in more than 500,000 women annually. More than 90% of deaths from cervical cancer occur in low- and middle-income countries. A common epidemiological feature of countries with high cervical cancer incidence is a high burden of intestinal helminth infection. The ability of intestinal helminths to trigger immunoregulation, resulting in a “tolerogenic” systemic immune environment, provides fertile soil for the persistence of oncogenic viruses such as HPV. Animal models have shown that intestinal helminth infection permits the persistence of some viruses, however, HPV-specific and human studies are lacking. Large, well-organized trials evaluating the consequences of intestinal helminth infection on the human immune system and HPV persistence may lead to improved strategies for HPV prevention in helminth-endemic regions of the world. Additionally, such studies would offer insight into the specific ways that intestinal helminth infection contributes to immunomodulation, which could identify new therapeutic targets for a range of diseases, from inflammatory disorders to cancer. In this review, we discuss the evidence for helminth-induced systemic and local immune dysregulation, discuss possible mechanisms by which chronic intestinal helminth infection may facilitate HPV persistence, and suggest novel helminth-related interventions that could offer a high leverage (if somewhat unconventional) approach to HPV and cervical cancer control in resource-constrained regions.

Eliminating Cervical Cancer in India: Challenges and Prospects

ABSTRACT. Cervical cancer is a malignancy with a well-established viral origin linked to high-risk human papillomavirus (HPV) types. Globally, there are 348,709 estimated deaths among 662,301 cervical cancer cases. India faces a disproportionately high burden, contributing to 79,906 of these deaths and accounting for over 22% of global deaths. The nation’s high mortality rate is attributable to the low rate of cervical cancer screening and HPV vaccination uptake. There is a greater impact of cervical cancer on those of lower socioeconomic status and a cultural stigma surrounding sexually transmitted infections. We recommend a comprehensive cervical cancer prevention strategy, including screening programs, culturally sensitive education for patients and providers, government-endorsed HPV vaccination, and continuing studies on diagnostics and vaccination in the Indian context.