Circulating genotypes of human papillomavirus in adult women of reproductive age from the Boeny region of Madagascar: a cross-sectional study to explore needs and opportunities for HPV vaccination in the country

TL;DR

This study examines HPV genotypes in women in Madagascar to guide the country's cervical cancer vaccination strategy.

Contribution

The study provides the first data on HPV genotype prevalence in rural Madagascar to inform vaccine selection.

Findings

44.6% of women tested positive for HPV, with high-risk genotypes HPV52, HPV45, and HPV51 being most common.

The 9-valent vaccine would cover 29.3% of HPV cases, offering greater protection than 2- or 4-valent vaccines.

The findings support the adoption of the 9-valent vaccine for a more effective cervical cancer prevention program.

Abstract

HPV is the most common sexually transmitted infection worldwide, related to the vast majority of cervical cancers (CC). Prevention through vaccination against HPV is considered one of the most effective control measures for CC. Madagascar is one of the few countries where HPV vaccination has not yet been widely disstrivuted in the country as the national program just started in December 2025. This study aims to estimate the prevalence of HPV genotypes in rural Madagascar in order to support the planning of a national vaccine implementation strategy.

A cross-sectional study was conducted between 2021 and 2022 in the Boeny region of Madagascar, involving women 18 to 49 years old. Cervico-vaginal lavages were collected and analysed for the presence of HPV DNA, covering 21 HPV genotypes. The prevalence of each HPV genotype was calculated as proportions with 95% confidence intervals (CI95%).

From a total of 927 women enrolled, 44.6% (n = 413, CI95%: 41.3, 47.8) tested positive for HPV. The most commonly detected high-risk genotypes were HPV52 8.3% (CI95%: 6.6, 10.3), HPV45 7.2% (CI95%: 5.6, 9.1), and HPV51 4.8% (CI95%: 3.5, 6.3). The prevalence of vaccine-target genotypes was 7.4% (CI95%: 5.8, 9.3), 10.8% (CI95%: 8.9, 13.0), and 29.3% (CI95%: 26.4, 32.4) for 2-valent, 4-valent, and 9-valent vaccines, respectively.

Our results suggest that for a vaccination strategy aimed at preventing CC in Boeny, adoption of the 9-valent vaccine would increase the impact of the program.

Not applicable.

The online version contains supplementary material available at 10.1186/s12879-026-12691-2.

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