title: Prevalence of HPV infection and other risk factors in a Fijian population.
abstract: BACKGROUND
  Cancer is among the leading contributors to morbidity and mortality in the Pacific, but the magnitude of the problem and the potential for prevention have not been comprehensively studied. Over the past decade, cervical cancer has been the most common cancer among women in Fiji with an age standardised cervical cancer incidence rate of 51 per 100,000. This rate is among the highest in the South Pacific region and in the world. This high cervical cancer incidence rate is likely linked to the low cervical screening rate, but it points also to the possibility of a high burden of human papillomavirus (HPV) infection.
  
  
  METHODS
  We conducted a population-based survey in Fiji to provide information on human papillomavirus (HPV) prevalence, and the distribution of individual HPV types in a Fijian health-sub-district. We included 1,261 women aged between 16 and 64 years. A general primer GP5+/6+ mediatedpolymerase chain reaction (PCR) assay was used for HPV testing of 44 HPV types.
  
  
  RESULTS
  The crude HPV prevalence in 1,244 women with an adequate HPV sample was 24.0% (95% confidence interval (CI), 21.7-26.4%) and the corresponding age standardised prevalence was 25.5% (95% CI, 23.1-28.1%). The prevalence of high-risk HPV types was 13.6% (95% CI, 11.8-15.6%). Among 1,192 women with adequate cytological results, 13 (1.1%) showed cervical abnormalities, the majority of which were high-grade intraepithelial lesions or worse. HPV prevalence declined from 35.8% in women aged <25 years to 18.6% in those aged 55-64 years of age. After adjustment, the only variables significantly associated with HPV-positivity were age (ranging from odds ratio (OR) 0.57 (95% CI, 0.36-0.89) for 25-34 year-old-women to OR 0.43 (95% CI, 0.20-0.89) for 55-64 year-old-women) and 'husband's extramarital sexual relationships' (OR 1.69; 95% CI, 1.17-2.34).
  
  
  CONCLUSIONS
  These findings on HPV provide key information for future policy decisions on the most appropriate methods of cervical cancer prevention in Fiji and in the Pacific region.
authors.affiliation: Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand.
authors.forename: Sunia
authors.initials: S
authors.lastname: Foliaki
authors.affiliation: Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand.
authors.forename: Naomi
authors.initials: N
authors.lastname: Brewer
authors.affiliation: Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Pearce
authors.affiliation: Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
authors.forename: Peter Jf
authors.initials: PJ
authors.lastname: Snijders
authors.affiliation: Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
authors.forename: Chris Jlm
authors.initials: CJ
authors.lastname: Meijer
authors.affiliation: Ministry of Health, Yaren, Nauru Island.
authors.forename: Lepani
authors.initials: L
authors.lastname: Waqatakirewa
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Clifford
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
keywords: Cervical neoplasia; Cervical screening; Fiji; HPV genotypes; Human papillomavirus (HPV)