Human Papillomavirus Prevalence, Genotypes, and Factors Associated with Cervical Abnormalities Among HIV-Positive and Negative Women in Eastern and Central Regions, Kenya

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dc.contributor.advisorMargaret Muturien_US
dc.contributor.advisorLucy Kamauen_US
dc.contributor.authorNjue, James Kinoti
dc.date.accessioned2023-01-17T12:36:58Z
dc.date.available2023-01-17T12:36:58Z
dc.date.issued2022
dc.descriptionA Thesis Submitted in Partial Fulfilment of the Requirement for the Award of the Degree of Doctor of Philosophy (Medical Virology) in the School ff Medicine of Kenyatta University, September, 2022en_US
dc.description.abstractHuman Papillomavirus (HPV) associated cervical cancer caused 3,286 deaths in 2019 in Kenya with a national cervical screening rate of only 3.2%. The overwhelming predominance of distinctive HPV genotypes infection has implications regarding the HPV vaccination efficacy. Approaches to reduce cervical cancer incidence and mortality by either ‘screen-and-treat” or “screen, triage and treat” are based on the diagnostic accuracy of available screening methods as well as awareness of the disease and its signs and preventive measures. This comparative study aimed to investigate the Human Papillomavirus prevalence, genotypes, and factors associated with cervical neoplasia among HIV-infected and non-infected women. The diagnostic accuracy of cervical screening methods was also determined. HIV-infected (cases) and non-infected (control) women aged 18-46 years women underwent cervical screening and colposcopy-biopsy confirmatory test alongside filling out a questionnaire on awareness of cervical cancer and its risk factors. A cervical broom was softly rotated 360 degrees five times to exfoliate cells from the region of the transformation zone, squamocolumnar junction, and endocervical canal for HPV genotyping, Pap smear followed by VIA/VILLI test. Laboratory outcome and questionnaire data statistical relationships were computed using the Pearson chi-square test. 161(50.8% cases and 156(49.2%) control, mean age: 34.3, SD ±10:4, range 18-46 years were recruited from Embu (85/317(26.8%)), Isiolo (64/317(20.2%)), Kirinyaga (56/317(17.7%)), Meru (81/317(25.6%)), and Tharaka-Nithi (31/317(9.8%)) Counties. 81/317(25.6%), 84/317(26.5%), 96/317(30.2%) and 78/122(63.9%) participants had VIA, HPV DNA-PCR, Pap smear and cervical histology positive results respectively. A higher primary diagnostic accuracy was established by HPV DNA-PCR (sensitivity: 95.5%; specificity: 92.6%) than Pap smear and VIA test while in triage testing, high sensitivity was obtained by HPV DNA-PCR parallel testing with VIA test (92.6%) and Pap smear test (92.7%). HPV genotypes distribution by cervical dysplasia were CIN1 (cases: HPV81 (12/317(3.8%)) and HPV11 (2/317(0.6%)); control: HPV53 and 66 co-infections (1/317 (0.3%)), CIN2 (cases: HPV11, HPV16, HPV66 ((1/317 (0.3%) each), HPV81 (6/317 (1.9%)); control: HPV81 (2/317(0.6%)) and Invasive Cervical Carcinoma (cases: HPV16 (1/317(0.3%)) and HPV81 (3/317(0.9%)). Most sample isolates had phylogenetic relationship with reference sequences from Iran [22.3% (17/76)], Kenya [22.3% (17/76)], Bangkok [14.4% (11/76] and India [7.9% (6/76)]. Knowledge of HPV screening was significantly influenced by residence, age, education level, married-marital status, religion, and hormonal contraceptive use (p<0.005). Fear of embarrassment was the main reason for failing to undergo cervical screening. HPV-PCR is recommended for routine testing and evaluation of Pap test results or during the treatment of cervical lesions. There was a higher frequency of both high-risk and low-risk HPV genotypes and the existence of non-vaccine HPV genotypes associated with cervical dysplasia among HIV-infected than HIV-uninfected women. Increased knowledge, willingness, and perceiving cervical screening as important, as well as personal acceptability to vaccinate against HPV, may reduce the cervical cancer burden. Keywords: Human Papillomavirus, cervical cancer, screening, genotyping, Knowledge, Attitude, Practice and Perception, HPV vaccinationen_US
dc.description.sponsorshipKenyatta Universityen_US
dc.identifier.urihttp://ir-library.ku.ac.ke/handle/123456789/24446
dc.language.isoenen_US
dc.subjectHuman Papillomavirusen_US
dc.subjectGenotypesen_US
dc.subjectCervical Abnormalitiesen_US
dc.subjectEastern Regionen_US
dc.subjectCentral Regionen_US
dc.subjectKenyaen_US
dc.subjectHIV-Positive Womenen_US
dc.subjectHIV-Negative Womenen_US
dc.titleHuman Papillomavirus Prevalence, Genotypes, and Factors Associated with Cervical Abnormalities Among HIV-Positive and Negative Women in Eastern and Central Regions, Kenyaen_US
dc.typeThesisen_US
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