# Prevalence and Genotypic Diversity of High-Risk Human Papillomavirus Among Women of Reproductive Age in Kilifi County, Kenya

## TL;DR

This study found a high rate of high-risk human papillomavirus (HPV) among women in Kilifi County, Kenya, with differences in HPV types between regions, suggesting the need for targeted screening and prevention.

## Contribution

The study provides new insights into HR-HPV prevalence and genotype distribution in a low-resource region of Kenya, highlighting regional differences and effective community-based screening methods.

## Key findings

- HR-HPV prevalence was 48.7% among women aged 15-50 in Kilifi County.
- HPV 18 and 45 were the most common genotypes, with co-infections being frequent.
- Self-sampling and community-based approaches increased participation and revealed regional genotype differences.

## Abstract

Background

Human papillomavirus (HPV) is the most common sexually transmitted infection and the primary cause of cervical cancer, a leading cause of cancer-related deaths among women in Kenya. Although many HPV infections resolve on their own, some high-risk types may persist and gradually develop into cervical cancer over several years, providing opportunities for early detection and intervention. However, in low-resource settings like Kilifi County, HPV testing is limited, and alternative screening methods like visual inspection with acetic acid (VIA) are commonly used despite their limitations.

Objective

This study aimed to assess the prevalence and genotype distribution of high-risk HPV (HR-HPV) among women of reproductive age in Kilifi County, Kenya, to inform targeted public health interventions.

Methodology

This study was nested within a more extensive cross-sectional study on female genital schistosomiasis and human immunodeficiency virus (HIV). We focus on a stratified sample of 320 women aged 15-50 from Rabai and Magarini sub-counties, Kilifi, Kenya, identified as Schistosoma haematobium hotspots. Participants provided informed consent, and pregnant women were excluded. Clinical data was collected and sociodemographic data collected via questionnaires, while high vaginal and cervical swabs were self-collected for HPV testing, screening for 24 HR-HPV genotypes.

Results

Data from 261 women were analyzed. The overall HR-HPV prevalence was 48.7%, with the Magarini sub-county showing a higher prevalence (31.4%) compared to Rabai (17.2%). The most prevalent HPV genotypes were HPV 18 (25.3%), HPV 45 (22.6%), and HPV 16 (12.6%). Co-infections were common, particularly with HPV 18 and 45. HPV 16 was more prevalent in the Rabai subcounty, while HPV 18 and 45 were more common in the Magarini subcounty. Significant associations were found between sexual partnership type, leukocyte levels, and HPV positivity.

Conclusion

Kilifi County exhibits a high prevalence of HR-HPV, with genotype variations across sub-counties, suggesting differences in risk factors and access to preventive measures. Self-sampling and community-based screening effectively increased participation and diversity in the study population, highlighting the need for targeted, age-specific screening programs and comprehensive HPV genotyping to enhance cervical cancer prevention strategies in the region.