Background
Cervical cancer remains a leading cause of cancer-related morbidity and mortality in sub-Saharan Africa, despite the availability of effective preventive strategies. Persistent infection with high-risk human papillomavirus (HR-HPV) is a necessary cause of cervical cancer. However, nationally representative data on HR-HPV prevalence, genotype distribution, and associated determinants are limited in West Africa, particularly in real-world screening settings.
 
Objectives
To estimate the national prevalence of HR-HPV infection among women in Senegal, describe the distribution of oncogenic HPV genotypes, and identify factors independently associated with HR-HPV infection.
 
Methods
We conducted a national, population-based, cross-sectional study across all 14 administrative regions of Senegal. Women of reproductive age attending primary health-care facilities were consecutively recruited using a multistage, stratified sampling strategy to ensure national representativeness. Cervical samples were analyzed centrally using the Anyplex II HPV28 assay for HPV DNA detection and genotyping. Liquid-based cytology was performed using the ThinPrep system. The primary outcome was HR-HPV infection, defined as the detection of at least one oncogenic HPV genotype. Univariable and multivariable logistic regression models were used to assess factors associated with HR-HPV infection, with results expressed as odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
 
Results
Among 2302 recruited women, 2211 were included in the final analysis. The mean age was 42.5 years (SD 11.1), and women aged 30–49 years represented 60.6% of the population. Overall HPV infection was detected in 617 women (27.9%). Of these, 484 harbored at least one HR-HPV genotype, yielding an overall HR-HPV prevalence of 21.9%. Multiple HPV infections were observed in 40.2% of HPV-positive women and 11.2% of the total population.
 
Cytology showed that negative findings or low-grade squamous intraepithelial lesions (LSIL) accounted for 86.4% of results, while high-grade squamous intraepithelial lesions (HSIL) and glandular abnormalities were rare (0.9%). HR-HPV infection was more frequent among women with cytological abnormalities, although category-specific associations were not consistently statistically significant.
 
A broad diversity of HPV genotypes was identified. The most prevalent HR-HPV types were HPV52 (11.5%), HPV16 (11.2%), HPV68 (10.2%), HPV58 (8.9%), HPV18 (8.6%), and HPV53 (8.3%). Non-HPV16/18 oncogenic genotypes predominated. In univariable analysis, age at first sexual intercourse was inversely associated with HR-HPV infection (OR per year increase 0.95, 95% CI 0.91–0.99). This association remained significant in multivariable analysis (aOR 0.95, 95% CI 0.91–0.99). No other variables were independently associated with HR-HPV infection.
 
Conclusions/Implications
HR-HPV infection affects more than one in five women in Senegal and is characterised by marked genotype diversity dominated by non-HPV16/18 oncogenic types. Early age at sexual debut is the main independent determinant of HR-HPV infection, underscoring the importance of timely HPV vaccination before sexual exposure and supporting the implementation of HPV DNA–based screening strategies tailored to local epidemiological profiles in low-resource settings.