Unveiling the burden of human papillomavirus infection and risk factors among Indigenous women in Mizoram, Northeast India
Human papillomavirus (HPV) infection is a significant public health concern globally, with its burden increasing in regions with limited access to screening and preventive measures. Understanding how HPV affects different populations is crucial, genetic background, behavioral factors, sexual health practices, co-infections, and access to screening and vaccination services significantly influence disease dynamics, prevalence of high-risk genotypes, and progression to malignancies such as cervical cancer. Such variations underscore the importance of region-specific epidemiological studies and serve as key predictors which can impact the well-being of the population. The study aims to investigate the prevalence and burden of HPV and its association with different risk factors among the indigenous Mizo women of Mizoram, Northeast India. This cross- sectional study was conducted among 1018 women age (20-73 years) from November 2023 to 2024 from different districts in Mizoram. Cervical swabs were collected in VTM after obtaining consent from the patients as well as the demographic and clinical data via a questionnaire. DNA-based HPV genotyping and Pap smear analysis were performed. Statistical analysis was performed by using SPSS version 22.0 software to determine the association between HPV and the risk factors. Out of the 1018 participants, findings revealed a 14.9% overall prevalence of HPV infection, with most participants being from the district capital, Aizawl (78.7%). Age group 51-60 years age group had a notable proportion of HPV-positive individuals (11.5%), they exhibited significantly lower odds of HPV infection compared to younger age groups (OR = 0.155, 95% CI: 0.038-0.632; p = 0.009). Most participants were married (93.3%) with 78.5% being housewives. Among different occupations, participants employed in government sectors have a higher odds ratio 1.898 of HPV infection suggesting potential occupational or lifestyle-related influence on infection risk. Key lifestyle factors such as betel nut consumption and early sexual debut are associated with increased infection risk. Cervicitis, chronic pelvic pain and multiple pregnancies were significant clinical indicators. Ingestion of oral contraceptives were less likely to be HPV positive than were those who did not ingest them (OR: 0.604, Cl: 0.399-0.915; p = 0.017). Pap smear results revealed associations with high-grade squamous intraepithelial lesions (p = 0.025). Genotypes HPV-16 (26.97%) and HPV-18 (17.11%) were the most prevalent genotypes. Approximately 23.4% of the patients presented with multiple genotype infections. This study underscores the importance of tailored public health strategies for high-risk regions such as Mizoram. These include promoting HPV vaccination, enhancing screening programs, and addressing sociocultural practices contributing to infection risk. While the cross-sectional design, female-only participation, and lack of follow-up limit causal interpretation and generalizability. Comprehensive interventions and awareness campaigns are crucial to mitigate the HPV burden and reduce the incidence of cervical cancer in this unique sociodemographic context.