Ivy Akinyi

Cervical cancer remains a significant public health burden in Sub-Saharan Africa and Kenya in particular. The causative role of HPV in development of cervical cancer has been well documented with HPV-16 accounting for up to 50% of cervical cancer cases. The Kenya National Cancer guidelines has developed preventative strategies like mass screening and HPV vaccination for girls aged 10-15years to promote the elimination of cervical cancer. Despite the efforts, the challenge persists in the Lake Victoria Basin(LVB), a region characterized by the HIV pandemic, limited access to preventive and curative healthcare services. The recent COVID-19 pandemic together with other confluence of factors has exacerbated HPV prevention and control efforts in the region. In this PhD, the current epidemiological landscape of HPV infection in the region is explored. Specifically, the research seeks to establish the prevalence, genotype distribution, risk factors, viral load, and genetic variation of human papillomavirus infection, particularly HPV-16 among women in the LVB-Africa and to compare part of these findings with those from a European population.

Infection with high-risk human papillomavirus type 16 (HPV-16) is associated with cervical oncogenesis. The prevalence of HPV-16 lineages has not been well investigated in Africa. There is a lack of comprehensive epidemiological data on the distribution and oncogenic potential of the different HPV-16 lineages and sub-lineages in these populations. Through systematic review and meta-analysis, we aimed to determine the prevalence of HPV-16 lineages among women in Africa between 1997 and 2023. Eight databases were searched, and studies that identified HPV-16 positive women with distinct HPV-16 lineages, and those that clearly defined an African population, were included. The eight databases include PubMed, PubMed Central, BVS, Embase, Cochrane Library, Scopus, Web of Science, and EBSCOhost. This protocol is registered in PROSPERO (CRD42023437748) and followed the PRISMA guidelines. Out of the 2698 studies that were screened, 12 studies met the inclusion criteria and were included in the systematic review and meta-analysis. Analysis of these 12 studies identified yielded 1209 HPV-16-positive samples based on distinct diagnostic tests. These samples were classified as lineage A (n = 556), lineage C (n = 278), lineage B (n = 235), and lineage D (n = 140). Overall, lineage A variants were found in 11 studies (556 samples), establishing an overall prevalence of 58% (95% CI: 0.31–0.80; I2 = 96.0%; τ2 = 2.924; p < 0.0001). Lineage C variants were identified in 8 studies (278 samples), with an overall prevalence of 39% (95% CI: 0.21–0.60; I2 = 84.1%; τ2 = 1.362; p < 0.0001). Lineage B variants were identified across 7 studies (235 samples), with a prevalence of 20% (95% CI: 0.09–0.37; I2 = 90.4%; τ2 = 1.109; p < 0.0001). Lineage D variants were identified across 5 studies (140 samples), and its overall prevalence was 10% (95% CI: 0.05–0.19; I2 = 89.1%; τ2 = 0.672; p < 0.0001). Women in Africa exhibit a varied distribution of the four HPV-16 lineages. The high prevalence of HPV-16 lineage A in the entire population calls for developing targeted interventions to maximize impact and effectiveness. Future studies that are standardized and include defined geographic region, cytological details, and individual patient data should be conducted to enhance robust findings.

Human papillomavirus (HPV) coinfection remains common globally. However, its clinical significance compared to mono-infection remains controversial. Further, the epidemiology of HPV genotype combination in coinfection is not well studied in Kenya. . Between June and August 2023, a cross-sectional facility-based survey enrolled 434 women aged 16–68 years using purposive sampling strategy. Structured questionnaire was obtained from each woman regarding demographic and sexual behavior characteristics. Cervical specimen was collected from each participant and analyzed using RIATOL assay to determine HPV genotypes and viral load. Overall, HPV 52 was the most frequently detected HPV strain. The mean HPV viral load was elevated among coinfected women than those with mono-infection but there was no evidence to support differences in viral load in the two groups (P = 0.113). Mono-infection was common (58.52%). HPV 16 was noted to have a near equal presence both in mono-infection and coinfection (52.17% and 47. 83%), respectively. HPV 33 (alpha 9) and 45 (alpha 7) had the greatest preference for each other compared to all other HPV interactions. HPV 52 is the most prevalent HPV in the population supporting the need for the nonavalent HPV vaccine. Mono-infection with HPV 16 remains common corroborating the relevance of bivalent vaccine in resource limited setting where nonavalent vaccines may be unavailable. The frequent coinfection preference of HPV 33 and 45 (alpha 9 and alpha 7, respectively) pauses the need for further concurrent characterization. HPV vaccination and education on safe sexual behaviors is key in reducing HPV coinfection.

Background: Persistent human papillomavirus (HPV) infection is considered the primary etiological factor for invasive cervical cancer. Understanding the epidemiology of circulating potential high-risk (HR) and HR HPV strains is essential in updating epidemiological knowledge and recommendations on genotype-specific vaccination development. This study determined the prevalence and factors associated with Potential HR/HR HPV among women attending selected reproductive health clinics in Lake Victoria Basin. Methods: A cross-sectional facility-based survey made up of 434 women aged 16–68 years was carried out in two selected facilities. Structured questionnaires were administered to collect participant clinical and social characteristics. Cervical specimens were collected and HPV genotyping was carried out using RIATOL HPV genotyping qPCR assay. Descriptive statistics followed by logistic binary regression was done using R version 4.3.2. Results: The overall prevalence of potential HR/HR HPV among women attending the selected reproductive health clinics was reported at 36.5% (158/434). Specifically, in the rural setting, Gobei Health Center, the prevalence was 41.4% (41/99) while in the urban setting-JOOTRH, it was 34.6% (117/335). The most prevalent potential HR/HR HPV are 52, 67, 16, 31, 39, 45, and 31 among women. Age was the main factor associated with HPV infection with women between the age of 30–39 having the highest risk (AOR = 0.3, CI:0.2–0.7, p < 0.001). Conclusion: In both rural and urban regions, potential HR/HR HPV infection among women attending reproductive health clinics at the selected facilities remains common. The study identifies the need for effective implementation and clinical follow-up process of cervical cancer control program in the LVB.

Background Persistent human papillomavirus (HPV) infection is considered the primary etiological factor for invasive cervical cancer. Understanding the epidemiology of circulating potential high-risk (HR) and HR HPV strains is essential in updating epidemiological knowledge and recommendations on genotype-specific vaccination development. In Lake Victoria Basin-LVB (Kisumu and Siaya Counties, Kenya), both the HIV burden, the post-COVID-19 pandemic environment and the population growth point to the need to study the current circulating strains. This study determined the prevalence and factors associated with Potential HR/HR HPV among women attending selected reproductive health clinics in LVB. The prevalence of Potential HR/HR HPV, genotype-specific distributions, and implications to the current HPV vaccination ongoing within Kenya are discussed. Methods A cross-sectional facility-based survey made up of 434 women aged 16-68 years was carried out in two selected facilities in the Urban-Kisumu County (Jaramogi Oginga Odinga Teaching and Referral Hospital-[JOOTRH] and rural-Siaya County (Gobei Health Center). Structured questionnaires were conducted to collect participant clinical and social characteristics. Cervical specimens were collected by registered reproductive health nurses and HPV genotyping was carried out using RIATOL HPV genotyping qPCR assay. Descriptive statistics followed by logistic binary regression was done using R version 4.3.2 Results The overall prevalence of potential HR/HR HPV among women attending the selected reproductive health clinics was reported at 36.5% (158/434). Specifically, in the rural setting, Gobei Health Center, the prevalence was 41.4% (41/99) while in the urban setting-JOOTRH, it was 34.6% (117/335). The most prevalent potential HR/HR HPV are 52, 67, 16, 31, 39, 45, and 31 for both HIV-positive and negative women and either in rural-Gobei Health Centre and Urban-JOOTRH. In this study, HIV status was not associated with potential HR/HR HPV among women attending. Age was the main factor associated with HPV infection among HIV-positive and negative women attending the selected reproductive health clinics in rural-urban Lake Victoria Basin, with women between the age of 30-39 having the highest risk (AOR=0.3, CI:0.2-0.7, p<0.001). Conclusion In both rural and urban regions, potential HR/HR HPV infection among individuals attending reproductive health clinics at the selected facilities remains common. The study identifies the need for effective implementation and clinical follow-up process of cervical cancer control program in the Lake Victoria Basin.