Evaluating the prevalence and factors associated with visual inspection with acetic acid (VIA) and high-risk HPV positivity among women in Zambia Open Access

Abstract

The aim of this study was to evaluate the prevalence and factors associated with VIA and hrHPV positivity among women at high risk of HIV/STI in Zambia. Cervical cancer, caused by certain HPV strains, poses a significant public health challenge in Zambia, characterized by high incidence and mortality rates. Despite the majority of HPV infections being transient, certain women develop precancerous lesions that can progress to invasive cancer if left untreated. Challenges in cervical cancer prevention include limited access to HPV vaccination and low screening rates. Despite government initiatives providing free VIA screening and HPV vaccination, screening rates remain low, influenced by cultural beliefs, accessibility issues, and inadequate knowledge. In this study we had a complementary reproductive health service to 477 single mothers (SMs) and female sex workers (FSWs) between the ages 18–45 in Lusaka and Ndola. The study participants had a median age of 26. A majority hailed from Lusaka (53%) and had completed primary education (54%), while 57% were employed. Among the participants, 46% tested positive for high-risk HPV (hrHPV+), with prevalent types including HPV 16, 18, and 45. Additionally, 26% had a positive result on VIA testing, and 72 women (15%) tested positive for both VIA+ and hrHPV+. We found significant associations between certain gynecological disturbances, such as inguinal adenopathy and inflammation of the cervix, with the outcome of interest, VIA+/hrHPV+. We found a very high prevalence of VIA, HPV, and VIA/HPV in this population that is also at high risk for HIV. Therefore, there is an importance to enhance HPV and cervical cancer screening among women that are at risk of HIV.

Table of Contents

CHAPTER I: Public Health Implication …….………………………………………………..1

CHAPTER II: Introduction …….…………………………………………..……………………2

CHAPTER III: Methods …………………………………………………………………...........5

CHAPTER IV: Results ……………………………………………………….…………….........9

CHAPTER V: Discussion…………………………………………………...………..………….11

REFERENCES…………………………………………………………………....………...……...14

FIGURE 1 ………………………………………………………………………….….....…………17

TABLE 1 ………………………………………………………………………………....……...…18

TABLE 2 …………………………………………………………………………………....……...19

TABLE 3 ……………………………………………………………………………….......………20

TABLE 4 ………………………………………………………………………...………....………21

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	HPV
Committee Chair / Thesis Advisor	Kristin M.Wall, Emory University

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