College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
Front Public Health. 2022 Jul 8;10:890880. doi: 10.3389/fpubh.2022.890880. eCollection 2022.
Among sub-Saharan African women, cervical cancer is steadily increasing with more than 75,000 new cases and 50,000 deaths annually. Due to the vast ethno geography variation, Africa harbors heterogeneous genotypes of HPV. High-risk HPV [hr HPV] genotypes such as hr HPV-16,-18,-35, and-52 are abundantly reported in sub-Saharan Africa. The purpose of this systematic review and meta-analysis is to generate an evidence on the prevalence and the genotype distribution of hr HPV among sub-Saharan African countries.
The review was conducted by following the preferred reporting items for systematic reviews and Meta-analysis. PubMed/Medline, Embase, Scopus, Google Scholar, Heath Technology assessment and Cochrane Library databases were used to retrieve published original studies between 2001 and 2021. It included studies that used PCR-based or hybrid testing to assess the presence of HPV DNA in a cervical biopsy, cervical swelling, and vaginal swelling. Statistical software for data science (STATA V16) software using a random-effects model was used to determine the pooled prevalence and type-specific distribution of HPV with 95% confidence intervals (CI). The I-squared statistic was used to describe the level of heterogeneity. The study protocol is registered on PROSPERO with reference number CRD42022311157.
The review included 27 studies conducted in 19 sub-Saharan countries. A total of 16,506 study participants from 27 studies were included in a systematic review and 5,303 of them were infected with the hr HPV infection. Out these, only 3,075 of them were eligible for meta-analysis. The incidence proportion of estimatesof hr HPV infection among study participants with different health conditions ranges from 10.7 to 97.2% while the pooled incidence proportion of estimates is 34% (95%CI: 29-39). Among 3,075 women, 424 (13.8%), 305 (9.9%) and 279 (9%) were infected with HPV-16,-52 and-18, respectively. HPV-16 and-52 are the main genotypes causing the hr HPV infection in the Eastern and Southern African sub-contents, whereas HPV-16 and-35 are the main genotypes in the Western African countries.
Depending on several factors, especially women's health conditions, the high rate of hr HPV infection with inconsistent genotype distribution shows that it is a growing public health challenge in sub-Saharan African countries. Therefore, to implement a vaccination-based prevention strategy and be effective, considering factors associated with hr HPV infection is crucial.
在撒哈拉以南非洲地区的女性中，宫颈癌的发病率呈稳步上升趋势，每年新增病例超过 7.5 万例，死亡人数超过 5 万例。由于人种地理差异巨大，非洲存在着多种 HPV 基因型。高危型 HPV（hrHPV）基因型，如 hrHPV-16、-18、-35 和-52，在撒哈拉以南非洲地区大量报道。本系统评价和荟萃分析的目的是为撒哈拉以南非洲国家的 hrHPV 流行率和基因型分布提供证据。
本综述遵循系统评价和荟萃分析的首选报告项目进行。使用 PubMed/Medline、Embase、Scopus、Google Scholar、卫生技术评估和 Cochrane 图书馆数据库检索了 2001 年至 2021 年期间发表的原始研究。研究包括使用基于 PCR 或杂交检测评估宫颈活检、宫颈肿胀和阴道肿胀中 HPV DNA 存在情况的研究。使用数据科学统计软件（STATA V16）软件采用随机效应模型确定 HPV 的汇总流行率和特定类型的分布，置信区间（CI）为 95%。I 平方统计用于描述异质性水平。该研究方案已在 PROSPERO 上注册，参考编号为 CRD42022311157。
本综述纳入了 19 个撒哈拉以南国家的 27 项研究。共有来自 27 项研究的 16506 名研究参与者纳入了系统评价，其中 5303 人感染了高危型 HPV。其中，只有 3075 人符合荟萃分析的条件。不同健康状况的研究参与者中估计的 hrHPV 感染发生率范围为 10.7%至 97.2%，而汇总发生率为 34%（95%CI：29-39）。在 3075 名女性中，分别有 424 名（13.8%）、305 名（9.9%）和 279 名（9%）感染了 HPV-16、-52 和-18。HPV-16 和-52 是导致东部和南部非洲亚区 hrHPV 感染的主要基因型，而 HPV-16 和-35 是西部非洲国家的主要基因型。
根据多种因素，尤其是妇女的健康状况，高危型 HPV 感染率高且基因型分布不一致，表明这是撒哈拉以南非洲国家日益严重的公共卫生挑战。因此，为了实施基于疫苗接种的预防策略并取得成效，考虑与 hrHPV 感染相关的因素至关重要。
