title: Human papillomavirus infection in Rwanda at the moment of implementation of a national HPV vaccination programme.
abstract: Cervical cancer is the most common female cancer in Rwanda that, in 2011, became the first African country to implement a national vaccination programme against human papillomavirus (HPV).
  
  
  
  To provide a robust baseline for future evaluations of vaccine effectiveness, cervical cell specimens were obtained from 2508 women aged 18-69 years from the general population in Kigali, Rwanda, during 2013/14. 20 % of women were HIV-positive. Samples were used for liquid-based cytology and HPV testing (44 types) with GP5+/6+ PCR.
  
  
  
  HPV prevalence was 34 %, being highest (54 %) in women ≤19 years and decreasing to 20 % at age ≥50. Prevalence of high risk (HR) HPV and cytological abnormalities was 22 and 11 % respectively (including 2 % with high-grade squamous intraepithelial lesions, HSIL) decreasing with age. Age-standardised prevalence of HR HPV was 22 % (or 19 % among HIV-negative women), and HPV16 was the most common type. Prevalence of HPV and cytological abnormalities were significantly higher in HIV-positive than HIV-negative women, and the difference increased with age. Other significant risk factors for HPV positivity in multivariate analyses were high lifetime number of sexual partners, receiving cash for sex, and being a farmer. 40 % of women with HSIL were infected with HPV16/18 and there was no significant difference between HIV-positive and HIV-negative women.
  
  
  
  This study confirms Rwanda to be a setting of high prevalence of HPV and cervical disease that is worsened by HIV. These data will serve as a robust baseline for future evaluations of HPV vaccine programme effectiveness.
authors.affiliation: Ministry of Health of Rwanda, Kigali, Rwanda.|Université Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium.
authors.forename: Fidele
authors.initials: F
authors.lastname: Ngabo
authors.affiliation: International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
authors.affiliation: International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Baussano
authors.affiliation: Ministry of Health of Rwanda, Kigali, Rwanda.
authors.forename: M Chantal
authors.initials: MC
authors.lastname: Umulisa
authors.affiliation: Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Peter J F
authors.initials: PJ
authors.lastname: Snijders
authors.affiliation: Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Uyterlinde
authors.affiliation: International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.|Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Lazzarato
authors.affiliation: International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Tenet
authors.affiliation: Ministry of Health of Rwanda, Kigali, Rwanda.
authors.forename: Maurice
authors.initials: M
authors.lastname: Gatera
authors.affiliation: Ministry of Health of Rwanda, Kigali, Rwanda.|Harvard Medical School, Boston, MA, USA.|Geisel School of Medicine, Dartmouth, Hanover, USA.
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
authors.affiliation: International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France. clifford@iarc.fr.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Clifford
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000276:immunology*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D015995:Prevalence; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D014611:Vaccination; D014932:Women's Health Services; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer; Human immunodeficiency virus; Human papillomavirus; Prevalence; Rwanda