Urine-Based High-Risk Human Papillomavirus (hrHPV) Screening for Cervical Cancer in Women Living with Human Immunodeficiency Virus (WLHIV): A cross-sectional study in Cameroon
1
Department of Virology, Centre Pasteur Du Cameroun, Yaounde, Cameroon
Popul. Med. 2026;8(Supplement Supplement 1):A2804
ABSTRACT
BACKGROUND:
Cervical cancer is a significant public health issue in low- and middle-income countries (LMICs), particularly affecting women living with HIV (WLHIV) due to persistent high-risk human papillomavirus (hrHPV) infections. Limited access to screening exacerbates this challenge. Non-invasive urine sampling presents a patient-friendly alternative, supporting the World Health Organization’s (WHO) goal to eliminate cervical cancer by 2030. In Sub-Saharan Africa, HPV16 and HPV18/45 are the most prevalent hrHPV types, though regional variations exist.
METHODS:
This cross-sectional study enrolled 721 WLHIV aged 25–49 years from seven centers in the West Region of Cameroon. Participants provided first-void urine samples and underwent pelvic exams for cervical sample collection. Both were tested for hrHPV genotypes (HPV16, 18/45, P3(31/33/35/52/58), P4(51/59), P5(39/56/66/68)) using real-time PCR on the GeneXpert® platform. Urine testing performance was evaluated for sensitivity and specificity against cervical results, with agreement assessed using Cohen’s kappa and McNemar’s test. Statistical analyses, including confidence intervals (CIs), were performed using Excel 2016.
RESULTS:
Among 721 paired samples, hrHPV prevalence was 30.6% (CI: 27.4–33.9%) for cervical and 36.8% (CI: 33.6–40.2%) for urine samples. Genotype-specific prevalences for cervical samples were P3: 17.5% (CI: 15.0–20.3%), HPV16: 6.1%, HPV18/45: 6.9%, P4: 3.5%, P5: 8.1%. For urine: P3: 17.9% (CI: 15.4–20.6%), HPV16: 7.0%, HPV18/45: 7.8%, P4: 5.8%, P5: 11.3%. Urine-cervical agreement was 82.1% (CI: 79.1–84.7%), with urine sensitivity of 80.9% and specificity of 82.6%. Cohen’s kappa was 0.60. Urine showed higher positivity (p<0.001).
CONCLUSIONS:
Urine-based hrHPV testing shows good sensitivity for WLHIV in Cameroon, supporting WHO’s cervical cancer elimination goals. The high prevalence of P3 suggests important implications for vaccine strategies using 9-valent HPV vaccine. Enhanced accessibility through urine sampling could facilitate scalable screening programs, though further investigation is needed due to false positives.
Cervical cancer is a significant public health issue in low- and middle-income countries (LMICs), particularly affecting women living with HIV (WLHIV) due to persistent high-risk human papillomavirus (hrHPV) infections. Limited access to screening exacerbates this challenge. Non-invasive urine sampling presents a patient-friendly alternative, supporting the World Health Organization’s (WHO) goal to eliminate cervical cancer by 2030. In Sub-Saharan Africa, HPV16 and HPV18/45 are the most prevalent hrHPV types, though regional variations exist.
METHODS:
This cross-sectional study enrolled 721 WLHIV aged 25–49 years from seven centers in the West Region of Cameroon. Participants provided first-void urine samples and underwent pelvic exams for cervical sample collection. Both were tested for hrHPV genotypes (HPV16, 18/45, P3(31/33/35/52/58), P4(51/59), P5(39/56/66/68)) using real-time PCR on the GeneXpert® platform. Urine testing performance was evaluated for sensitivity and specificity against cervical results, with agreement assessed using Cohen’s kappa and McNemar’s test. Statistical analyses, including confidence intervals (CIs), were performed using Excel 2016.
RESULTS:
Among 721 paired samples, hrHPV prevalence was 30.6% (CI: 27.4–33.9%) for cervical and 36.8% (CI: 33.6–40.2%) for urine samples. Genotype-specific prevalences for cervical samples were P3: 17.5% (CI: 15.0–20.3%), HPV16: 6.1%, HPV18/45: 6.9%, P4: 3.5%, P5: 8.1%. For urine: P3: 17.9% (CI: 15.4–20.6%), HPV16: 7.0%, HPV18/45: 7.8%, P4: 5.8%, P5: 11.3%. Urine-cervical agreement was 82.1% (CI: 79.1–84.7%), with urine sensitivity of 80.9% and specificity of 82.6%. Cohen’s kappa was 0.60. Urine showed higher positivity (p<0.001).
CONCLUSIONS:
Urine-based hrHPV testing shows good sensitivity for WLHIV in Cameroon, supporting WHO’s cervical cancer elimination goals. The high prevalence of P3 suggests important implications for vaccine strategies using 9-valent HPV vaccine. Enhanced accessibility through urine sampling could facilitate scalable screening programs, though further investigation is needed due to false positives.
| eISSN: | 2654-1459 |
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