High-risk human papillomavirus prevalence and factors associated with testing positive in women living in Montserrat

Montserrat is a UK Overseas Territory in the Caribbean without a universal human papillomavirus (HPV) vaccination programme for its population of 4,386. Montserrat operates limited colposcopy and cervical cancer screening services, therefore lacking evidence to determine the prevalence of high-risk HPV associated with cervical cancer. We aimed to determine the prevalence of high-risk HPV and factors associated with testing positive in women in Montserrat to inform preventive strategies. Using 2023 census data, we applied random spatial sampling to select 520 buildings and recruit 208 women based on an estimated high-risk HPV prevalence of 20%, with 5% precision at 5% significance level, anticipating a 40% response rate. Resident women aged 25–64 years were invited to participate and given the choice between self-collection or clinician-administered sampling. Samples were tested with the GeneXpert assay for 14 high-risk HPV genotypes. Sampling weights were applied to reflect the age distribution in the population. Known risk factors associated with high-risk HPV positivity were collected via questionnaire (including age group) and prevalence ratios calculated using binomial regression. Of 225 eligible women, 206 (92%) consented to participate with 187 women submitting a sample (83% of those eligible). 96% opted for self-sampling. All eligible age groups were represented in the study population. Overall high-risk HPV prevalence was 14.6% (95%CI:10.2-20.6); prevalence of HPV16 was 1.9% (95%CI:0.7-5.1) and HPV18/45 was 1.6% (95%CI:0.5-5.0) respectively. Prevalence of a positive test increased with younger age and those aged 25–34 years had three‐fold greater prevalence compared to 55–64 years (PR = 3.16, 95%CI:0.93–10.7; p = 0.064). Our findings suggest that vaccine-preventable high-risk HPV is present in the female population in Montserrat, with a trend of increased prevalence in younger age groups consistent with findings from previous Caribbean Island studies. Universal or age-targeted screening and vaccination programmes should be considered. Self-sampling HPV testing was highly acceptable to women

Cervical cancer · Cervical cancer screening · Cervical screening · Colposcopy · Human papillomavirus · Population · Prevalence · Cervical Cancer and HPV Research · Epidemiology · Head and Neck Cancer Studies · Reproductive tract infections research