Prevalence, Genotype Distribution and Risk Factors for Cervical Human Papillomavirus Infection in the Grand Tunis Region, Tunisia.
Implementation of Human Papillomavirus (HPV) vaccination should be considered a key cervical cancer prevention strategy in Tunisia, where Pap smear screening is not efficient. This study aims to estimate the prevalence and to identify risk factors associated with HPV infection among women from Grand Tunis, Tunisia. We conducted a cross-sectional study, between December 2012 and May 2013. Eligible women for this study were those aged 18-65 years, sexually active, who sought medical attention at their primary health care centre or clinic in Grand Tunis, Tunisia and who gave written consent. A liquid-based Pap smear sample was obtained from all women using a cervical brush. Only women with betaglobin positive test were further analysed for HPV detection and typing. A nested-PCR of the L1 region was performed followed by reverse line blot hybridization to facilitate the specific detection of 31 HPV genotypes. Multiple logistic regression modeling was used for the analysis of associations between variables with some considered possible confounders after checking for interactions. A total of 391 women were enrolled in this study and 325 out of the 391 cervical samples were positive for the betaglobin test. Overall HPV prevalence was 13.2% [9.8%-17.5%], with the following most prevalent HPV genotypes: HPV6 (40%), HPV40 (14%), HPV16 (12%), HPV52 (9%), HPV31 and HPV59 (7%), followed by HPV68 (4%). Mean age of HPV positive women was 40.7±0.92 years. Independently associated risk factors of HPV infection were smoking (OR:2.8 [0.8-9.6]), low income (OR:9.6 [1.4-63.4), bad housing type (OR:2.5 [1-6.8]), partner with multiple sexual relationship (OR:4.5 [0.9-22.9]) and single women (widowed, divorced, separated, never married) (OR:6.9 [1.1-42.2]). This study provides the first national-based estimate of HPV prevalence in Tunisia. Our findings contribute to the evidence on the current burden of HPV infection, the critical role of sexual behaviour and socioeconomic status and call for increased support for the screening program in Tunisia to prevent cervical cancer. These results allow us to evaluate the cost-effectiveness of vaccine program implementation in Tunisia in future.
Department of Molecular Epidemiology of infectious diseases, Institut Pasteur de Tunis, Tunis, Tunisia.|Department of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia.
Monia
http://orcid.org/0000-0002-9016-8987
M
Ardhaoui
Department of Molecular Epidemiology of infectious diseases, Institut Pasteur de Tunis, Tunis, Tunisia.|Department of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia.
Emna
E
Ennaifer
Department of Epidemiology, Observatoire National des Maladies Nouvelles et Emergentes de Tunis, Tunis, Tunisia.
Hajer
H
Letaief
Department of Epidemiology, Observatoire National des Maladies Nouvelles et Emergentes de Tunis, Tunis, Tunisia.|Department of Disease Prevention and Control, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.
Rejaibi
R
Salsabil
Department of Molecular Epidemiology of infectious diseases, Institut Pasteur de Tunis, Tunis, Tunisia.|Department of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia.
Thalja
T
Lassili
Department of Epidemiology, Observatoire National des Maladies Nouvelles et Emergentes de Tunis, Tunis, Tunisia.|Department of Disease Prevention and Control, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.
Karim
K
Chahed
Department of Epidemiology, Observatoire National des Maladies Nouvelles et Emergentes de Tunis, Tunis, Tunisia.
Souha
S
Bougatef
Department of Epidemiology, Observatoire National des Maladies Nouvelles et Emergentes de Tunis, Tunis, Tunisia.
Asma
A
Bahrini
Department of Molecular Epidemiology of infectious diseases, Institut Pasteur de Tunis, Tunis, Tunisia.|Department of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia.
Emna
E
El Fehri
Department of Molecular Epidemiology of infectious diseases, Institut Pasteur de Tunis, Tunis, Tunisia.|Department of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia.
Kaouther
K
Ouerhani
Department of Disease Prevention and Control, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.
Adela
A
Paez Jimenez
Department of Molecular Epidemiology of infectious diseases, Institut Pasteur de Tunis, Tunis, Tunisia.
Ikram
I
Guizani
Department of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia.
Med Samir
MS
Boubaker
Department of Epidemiology, Observatoire National des Maladies Nouvelles et Emergentes de Tunis, Tunis, Tunisia.
Nissaf Bouafif Ép
NB
Ben Alaya
D000328:Adult; D002584:Cervix Uteri / Q000821:virology*; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics* / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000627:therapeutic use; D010865:Pilot Projects; D015995:Prevalence; D012307:Risk Factors; D012747:Sexual Partners; D012959:Socioeconomic Factors; D014416:Tunisia / Q000453:epidemiology
D053918:Papillomavirus Vaccines