Background
Persistent infection with high-risk human papillomavirus (hrHPV) is the principal cause of cervical cancer. While HPV vaccination offers highly effective primary prevention, measurable reductions in cervical cancer incidence occur only after long latency periods. Consequently, monitoring changes in the prevalence of vaccine genotypes provides an important early indicator of vaccination impact. This study assessed the baseline prevalence and genotype distribution of 14 hrHPV (and 14 lrHPV) types among cohorts of unvaccinated women from the general population of Zimbabwe. These data establish a reference point for ongoing surveillance and evaluation of the vaccine’s impact.
Methods
HPV genotyping was performed using Allplex 28 HPV test on self-collected first-void urine specimens from women aged 19-23 years recruited at four clinical research sites in Zimbabwe between September 2022 and August 2023. All participants completed a risk-factor questionnaire capturing socio-economic characteristics, sexual behaviours and self-reported HIV and HPV vaccination status. Overall and type-specific hrHPV prevalence were estimated and stratified by recruitment side and age group. Prevalence ratios (PRs) for HPV positivity and corresponding 95% confidence intervals (CIs) for assessed risk factors were calculated using a binomial regression model with a log link. All analyses were conducted using Stata17 software .
Results
A total of 2545 women aged 19-23 years old were recruited from the general population at four clinical research sites in Harare and Chitungwiza. Of these, 2537 completed all study procedures and were included in the final analysis. Among included participants, 2416 (95%) reported no prior HPV vaccination, and 1903 (75%) indicated they had never heard of the HPV vaccine. Overall, 1382 (55%) participants tested positive for HPV of any type, of whom 847 (61%) were infected with multiple HPV types. hrHPV infection was detected in 946 (37%) participants. HPV prevalence ranged from 52% to 56% across age groups, with no significant differences observed between clinical research sites. Overall, 435 (17%) of participants tested positive for HPV genotypes targeted by the quadrivalent vaccine, while 283 (11%) were positive for HPV 16/18. Increasing lifetime number of sexual partners was statistically associated with higher HPV prevalence (p<0.001), with adjusted PRs of 1.20 (95% CI: 1.09-1.32), 1.27 (95% CI 1.14-1.41), and 1.41 (95% CI: 1.27-1.56) for two, three, and four or more lifetime sexual partners, respectively. Among the 131 women who reported living with HIV, overall and hrHPV prevalence were 66% and 49%, respectively.
Conclusion
This study demonstrates a high burden of HPV and hrHPV infection among women in Zimbabwe, with consistently high prevalence across age groups and clinical research sites and disproportionately higher rates among women living with HIV. The limited awareness of HPV underscores critical gaps in prevention efforts. These findings provide a robust baseline for post-vaccination surveillance and highlight the urgent need to strengthen HPV education and vaccine delivery. Planned follow-up surveys in vaccinated cohorts will generate essential evidence to evaluate vaccine impact and inform policy and resource allocation for cervical cancer prevention.