title: Human papillomavirus prevalence and type-specific distribution of high- and low-risk genotypes among Malagasy women living in urban and rural areas.
abstract: Cervical cancer (CC) is the most common cancer among sub-Saharan African women. Efficient, global reduction of CC will only be achieved by incorporation of human papillomavirus (HPV) vaccination into existing programmes. We aimed to investigate the overall and type-specific prevalences and distributions of oncogenic HPVs.
  
  
  
  A total of 1081 women aged 30-65 years were recruited to three sequential studies in Madagascar. Demographic and historical data were obtained from participants, and specimens were self-collected for HPV testing using real-time polymerase chain reaction. HPV-positive women underwent detailed pelvic examination, visual inspection of the cervix with acetic acid, biopsy, and endocervical curettage. Data were analysed using χ(2) and t-tests, and logistic regression.
  
  
  
  The prevalence of all 19 high-risk types of HPV was 39.3%. There were no differences in the prevalences of HPV and CC between rural and urban Malagasy women. The most common high-risk HPV types were HPV-53 (6.2%) and HPV-68 (5.8%), followed by HPV-52 (5.2%), HPV-35 (4.5%), HPV-73 (3.4%), HPV-31 (3.4%), HPV-16 (3.1%), and HPV-18 (3.1%). The prevalence of cervical intraepithelial neoplasia≥grade 2 (CIN2+) was 9.4%. CIN1-CIN3 lesions were more common in women in their 30s. The median age of participants with CIN2+ was 44 years (range 37-55). Overall, 25.8% of CIN2+ cases were associated with HPV-16/18.
  
  
  
  This study provides evidence to support the introduction of HPV vaccination in eastern African countries such as Madagascar. Further studies are needed to screen younger women and adolescents, to provide a global vision of HPV genotype distributions and to maximize the impact of HPV vaccination.
authors.affiliation: Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1206 Geneva, Switzerland. Electronic address: rosapintocatarino@gmail.com.
authors.forename: Rosa
authors.initials: R
authors.lastname: Catarino
authors.affiliation: Geneva Foundation for Medical Education and Research, Route de Ferney 150, 1211 Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Vassilakos
authors.affiliation: Saint Damien Medical Centre, Ambanja, Madagascar.
authors.forename: Jeromine
authors.initials: J
authors.lastname: Jinoro
authors.affiliation: Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1206 Geneva, Switzerland.
authors.forename: Celine
authors.initials: C
authors.lastname: Broquet
authors.affiliation: Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1206 Geneva, Switzerland; Saint Damien Medical Centre, Ambanja, Madagascar.
authors.forename: Anne-Caroline
authors.initials: AC
authors.lastname: Benski
authors.affiliation: Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1206 Geneva, Switzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Meyer-Hamme
authors.affiliation: Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1206 Geneva, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Petignat
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005838:Genotype; D006801:Humans; D008270:Madagascar; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000821:virology*; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000235:genetics* / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000821:virology*
keywords: Cervical cancer; Developing country; HPV testing; HPV vaccination; Prevention