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. 2025 Apr 14;20(1):24.
doi: 10.1186/s13027-025-00655-1.

Evaluation of hpv risk groups among women enrolled in the mulher cervical cancer screening study in Mozambique

Cristina Mendes de Oliveira  1 , Ricardina Rangeiro  2 , Nafissa Osman  2   3 , Ellen Baker  4 , Andrea Neves  5 , Arlete A N Mariano  6 , Guilhermina Tivir  7 , Joseph P Thomas  8 , Jennifer Carns  9 , Viviane Andrade  10 , Carla Carrilho  2   3 , Eliane C S Monteiro  6 , Hannah Hoover  7 , Edson Chivambo  7 , Marcos Chissano  7 , Elizabeth Chiao  11 , Hira Atif  3 , Philip E Castle  12 , Rebecca Richards-Kortum  9 , Eva Lathrop  7 , Kathleen M Schmeler  4 , Cesaltina Lorenzoni #  2   3   13 , Mila P Salcedo #  14
Affiliations

Evaluation of hpv risk groups among women enrolled in the mulher cervical cancer screening study in Mozambique

Cristina Mendes de Oliveira et al. Infect Agent Cancer. .

Abstract

Background: Limited data are available about the distribution of human papillomavirus (HPV) among women undergoing cervical cancer screening in Mozambique. We describe the prevalence of high-risk HPV risk groups detected in women who participated in the MULHER Study, a prospective trial of Mozambican women undergoing cervical cancer screening with HPV testing.

Methods: From January 2020 to January 2023, 9,014 women aged 30-49 years in Maputo City and Gaza Province, Mozambique underwent cervical cancer screening. Cervicovaginal samples were self-collected (97.5%) or provider-collected (2.5%) and primary HPV testing was performed using the GeneXpert HPV testing platform (Cepheid Inc, USA) which provided data on HR-HPV risk groups: HPV16, HPV18/45 and 11 other HR-HPV types in aggregate. Women with a positive HR-HPV test underwent visual assessment using dilute acetic acid applied to the cervix for treatment decisions.

Results: Of the 9,014 women enrolled in the MULHER Study, 8,954 (99.3%) had a valid HPV test result. Of those, 2,805 (31.3%) tested positive for at least one HR-HPV group: HPV16 (n = 475, 16.9%), HPV18/45 (n = 686, 24.6%) and other HR-HPV (n = 2,150, 77.1%). A total of 17.8% were positive for multiple HPV HR groups. HR-HPV infection prevalence was higher among women living with HIV (WLWH) than HIV-negative women (39.7% vs. 24.3% respectively; p < 0.001). WLWH were more likely to test positive for HPV18/45 (p = 0.03) and for two or more HR-HPV risk groups (P < 0.0001) compared with HIV-negative women. HPV16 was the most frequently detected HR-HPV group (56.7%) among women diagnosed with invasive cervical cancer.

Conclusions: HR-HPV prevalence was high among Mozambican women aged 30-49 years, especially among WLWH, consistent with the high burden of cervical cancer in this population. HPV16 was the most common HR-HPV group among women with cervical cancer. Further study is needed to determine the role of HR-HPV genotyping in follow-up and treatment in Mozambique.

Keywords: Cervical cancer; HPV; Screening.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Institutional Review Board from MD Anderson Cancer Center (2020 − 0651) and the Comité Nacional de Bioética para a Saúde, Moçambique (IRB00002657), and all patients provided written informed consent. Consent for publication: Not applicable. Competing interests: Dr. Castle has received HPV tests and assays for research at a reduced or no cost from Cepheid and Atila BioSystems. The other authors have no relevant financial or non-financial interests to disclose. Disclaimer: Opinions expressed by the authors are their own and this material should not be interpreted as representing the official viewpoint of the U.S. Department of Health and Human Services, the National Institutes of Health, or the National Cancer Institute.

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