Global Burden Estimation of Human Papillomavirus Infections (GLOBE-HPV)

Background

The World Health Organization (WHO) has adopted a global strategy towards the elimination of cervical cancer that calls for 90% of girls aged 9–14 to be fully vaccinated by 2030. Unfortunately the global uptake of HPV vaccination among this age group remains low. There is therefore a need to better understand the burden of HPV among girls and women in countries where interventions against cervical cancer or HPV infection are limited or non-existent. Additionally, there is limited data on the prevalence of HPV infection among subpopulations of girls and women vulnerable to acquiring HPV infection who cannot easily access public health interventions, such as commercial sex workers or displaced populations.

Understanding the trends of HPV infection and its associated risk factors in the general population and high-risk groups of women and girls can help identify subgroups that continue to be at high risk of infection. Similarly, a better understanding of potential barriers to effective programs, such as perceptions of gender norms, stigma and gender-related dynamics that may influence HPV burden or create barriers to access and uptake of HPV prevention, screening, and treatment services, can assist national and global public health officials to target and implement effective prevention and treatment strategies.

Primary objective

This study aims to: a) estimate the prevalence of HPV 16 and 18 infections among representative samples of girls and women in pastoralist and refugee communities in Tanzania, b) estimate the incidence of persistent HPV 16 and/or 18 infections lasting over 6 months in a period of two years in women from the general population and those working in recreational facilities in fishing, mining and truck stop communities, c) determine the risk factors for HPV infections, including sexual behaviours, and d) define the comparability of HPV genotyping results obtained from urine and self-collected vaginal swabs.

Methods

Cross-sectional studies will be conducted among pastoralists and refugees, enrolling 500 girls and women aged 12–35 and 9–50, respectively in each community to determine the prevalence of HPV infection. Longitudinal studies will be conducted in the general and high risk populations, with girls and women aged 25–35 and 15–35 respectively, to determine the incidence of persistent high risk HPV types. Urine and self-collected vaginal swabs will be tested for detection and typing of HPV. Using standardised questionnaires, the study will also collect information on socio-economic status, sexual and reproductive history, attitudes towards and awareness of cervical cancer screening and HPV vaccination, and potential risk factors for HPV infection and cervical cancer, as well as knowledge of HPV and attitudes, uptake, and use of vaccines.

Multi-country lead investigator:International Vaccine Institute, Republic of Korea: Julia Lynch

Collaborators

International Vaccine Institute, South Korea: Daniel Chulwoo Rhee, Deok Ryun Kim, Young Ae You, Yubin Lee, Indriana Permatasari, Soim Park; International Vaccine Institute European Regional Office, Sweden: Nigus Telele; Karolinska Institute, Sweden: Anna Kågesten, Anna Mia Ekström, Elin Larsson, Sibylle Herzig van Wees; US Centers for Disease Control and Prevention, USA: Elizabeth Unger, Troy Querec, Lauri Markowitz; Laval University, Canada: Marc Brisson; Kenya Medical Research Institute, Kenya/University of Washington; USA: Nelly Mugo; MITU, Tanzania; Elialilia Okello, Ramadhani Hashim, MITU, Tanzania/London School of Hygiene & Tropical Medicine (LSHTM), UK: Saidi Kapiga, Philip Ayieko, Jackton Indagasi; LSHTM, UK: Hilary Whitworth, Edward Choi, Shelley Lees, Kathy Baisley, Bolarinde Lawal, Farba Faye,Yusupha Njie

Deborah Watson-Jones

John Changalucha

Severin Kabakama