Mihret, Adane(Dr.)Gebremariam, Gebremeskel2018-11-092023-11-052018-11-092023-11-052018-07http://etd.aau.edu.et/handle/123456789/14079Human Papillomavirus (HPV), the sole causative agent of cervical cancer, is the most common sexually transmitted viral infection globally. Specifically, persistent infection with high-risk HPV types is the main risk factor for cervical cancer initiation and progression. However, the risk factors for its acquisition and induction of cervical cancer are widespread in resource limited countries like Ethiopia. In Ethiopia, cervical cancer is the second most frequent cancer, next to breast cancer, among the entire female population with estimated 7,095 and 4,732 annual cases and mortality, respectively. However, there are effective vaccines and many alternative intervention strategies that could reduce about two-third of its occurrence. At the same time ingredient for instituting HPV and cervical cancer intervention strategies, identifying circulating HPV genotypes, is lacking in Ethiopia. Therefore, the aim of this PhD project was to determine the molecular epidemiology of HPV among a population of women visiting gynecology clinics in the North and Central part of Ethiopia. A cross-sectional study was conducted from September/2015 to January/ 2016 in Addis Ababa, Dessie, Mekelle, Bahr Dar and Gondar. Cervical swabs were collected from 915 women attending gynecological clinics using PapCone® in PreservCyt buffer. Total DNA was extracted using Maxwell blood kit. HPV was genotyped by multiplex Polymerase Chain Reaction (PCR) using GP5+/6+ primers and readout by Luminex xMAP200 technology. The genotyping method was able to detect 14 high-risk HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 (a/ b), five putative high-risk HPV 26, 53, 70, 73 and HPV 82, and seven low risk HPV6, 11, 42, 43, 54, 72 and HPV 90 types. Moreover, STI and BV associated infections were typed using similar method, i.e. PCR and Luminex xMAP200 technology. The mean age of study participants was 37.7(±10.3) years. Analysis of HPV genotyping results confirmed that HPV DNA was detected in 33.9% (310/915) of samples. The five most prevalent high-risk HPV types identified were HPV16 (10.3%), 52(5.6%), 56 (4.2%), 59(4.1%), and HPV 35 (3.5%) in their decreasing order of prevalence. HPV 16 was exceedingly the most prevalent HPV type identified with prevalence of (94/915) and 30.3% (94/310) of all and HPV positive samples, respectively. Among HPV positive samples, high-risk HPV types were the most prevalent infections identified, 55.5% (172/310) followed by mixed HPV infections, 25.2% (78/310), putative high-risk 12.6% (39/310) and low risk 6.8%(21/310) HPV types. Overall, at least one high-risk HPV positivity was 80.3% (249/310) and 42.9% (133/310) X of the women had multiple HPV infections (2.84±1.5), with maximum of 12 HPV genotypes identified. Moreover, the prevalence and distribution of HPV genotypes was different among different sites. Among HPV associated sexually transmitted infections, HSV-2, T. vaginalis and N. gonorrhea were the most prevalent agents identified. Although, the prevalence of STI was lower than reported elsewhere, HPV infection was significantly (p=0.002) higher among STI positive women than their STI negative counterparts. Among them, HPV infection was significantly associated (OR:3.14; p<0.05) with HSV-2 than STI negative counterparts. Bacterial vaginosis associated infections were relatively high among our study participants. Besides, HPV infection was significantly associated to G. vaginalis and A. vaginae coinfection (OR: 1.64; p<0.05) and the three (p<0.05). Consequently, HPV infection was significantly associated with very strong BV score (p<0.05). Total cervical abnormality was 19.1% (175/915) of which 19.6% (59/301) and 18.9% (116/614) women were Pap smear and VIA positive, respectively. HPV infection was responsible for 30.5% (18/59) and 38.8% (45/116) of Pap smear and VIA positive women, respectively. Moreover, HPV 16 was the most important genotype associated with cervical abnormalities. The prevalence of both HPV and pathological finding showed that there is clear difference among our study sites. Therefore, the results indicated that high-risk and multiple HPV infection, among the investigated population, was high implying the risk of developing cervical cancer could be high in the future. Unlike previous reports the awareness level of cervical cancer is improving (66.7%) and 28.7% were screened at least once before this study. Screening strategies including HPV genotyping, vaccination, awareness creation employing health professionals especially extension health workers would be effective in preventing cervical cancer in Ethiopia.en-USHPV, Genotypes, Prevalence, Epidemiology, BV, Cervical Cancer, STI, EthiopiaThesis