CONCEPT: Comprehensive cervical cancer prevention in Tanzania 

Project description

Background: The natural history of Human papillomavirus (HPV) in sub-Saharan Africa is not yet fully understood and information about how HIV together with other risk factors interacts withHPV acquisition and HPV persistence/clearance is warranted. Additionally, concern prevails about the quality of cervical cancer preventive strategies in sub-Saharan Africa. Against this background the project aims to provide a better understanding of the natural history of HPV with a view to HIV status.

Objective: The project aims to: 1) Describe acquisition patterns of High Risk (HR)-HPV infections, with a special view to HIV status and to 2)  Describe the persistence/clearance patterns of High HR-HPV infections, with a special view to HIV status.

Methodology: The study will be linked up with the existing cervical cancer screening program at Ocean Road Cancer Institute and Kilimanjaro Christian Medical Centre and will include 4000 women who are attending screening service. HPV acquisition and persistence/clearance patterns will be determined through a follow up study lasting 36 months.  Based on our previous experiences, 800 of the women will be HR-HPV positive and 400 will be HIV positive. Information on socio-economic characteristics, lifestyle factors and reproductive history will be recorded. Blood samples for HIV testing and vaginal samples for HR-HPV testing will be obtained. The study will be divided in two sub-studies according to the specific objectives: Sub-study 1: Acquisition patterns of HR-HPV will be determined in a subsample of 800 HR-HPV negative women who will be invited for new HPV testing after 12 months, 24 months and 36 months. The association between HR-HPV acquisition and the women’s age, life style characteristics, reproductive history and HIV status will be assessed. Sub-study 2: Persistence/clearance patterns of HR-HPV will be determined among all HR-HPV positive women who will be tested for HR-HPV after 12, 24 and 36 months. HR-HPV persistence/clearance patterns will be described in relation to the women’s age, life style characteristics, reproductive history, HIV status and HPV genotype.