Patterns of high-risk HPV positivity in Janakpur, Nepal: Implications for scalable cervical cancer screening.

Abstract

e13632 Background: Cervical cancer prevention in Nepal is constrained by the absence of a national HPV vaccination program and low uptake of opportunistic screening. Scalable, point-of-care high-risk HPV (HrHPV) testing may improve screening access in resource-limited settings. Methods: We conducted HrHPV screening using the AmpFire HPV Screening Assay among women from two communities in Janakpur, Nepal - Kapileshwar (Ward 16) and Mahua (Ward 18). Associations between HrHPV positivity and sociodemographic characteristics, cervical cancer awareness, procedural knowledge, healthcare decision-making, and information sources were examined. Of 293 enrolled participants, 274 valid tests were obtained. Multivariable logistic regression was performed among participants with valid samples. Genotype results were summarized among HrHPV-positive tests as single-type infection vs coinfection and categorized as HPV16, HPV18/45, Group A and Group B. Results: Overall HrHPV positivity was 11.7% (32/274), with positivity rates in Kapileshwar at 16.5% and in Mahuwa at 9.0%. HPV16 was the most prevalent genotype, detected in 56.3% of infections (n = 18; 14 single infections and 4 coinfections). Coinfections were detected in 18.8% (6/32) of HrHPV-positive women. In multivariable analysis, residence in Mahuwa was associated with lower odds of HrHPV positivity compared with Kapileshwar (aOR = 0.39, 95% CI 0.16 - 0.93; p = 0.033). HrHPV positivity was also higher among women lacking procedural knowledge of vaginal sample collection (p = 0.019) and among those relying on informal rather than formal information sources (p = 0.018), particularly in Kapileshwar. Conclusions: HrHPV prevalence varied across Janakpur, with higher rates in Kapileshwar and a predominance of HPV16, including coinfections. Positivity was greater among women lacking procedural knowledge and those relying on informal information sources, highlighting the importance of targeted education and clear communication. These findings support the use of point-of-care HrHPV testing combined with practical counseling to improve screening readiness and follow-up in high-risk populations. Keywords: High-risk HPV (HrHPV), AmpFire, HPV16, Genotype distribution, Coinfection, Point-of-care testing, Procedural knowledge, LMIC HrHPV Subtype distribution. Subtype Category n % HPV 16 (Single Infection) 14 43.8% Other HrHPV Group A (39/51/56/59/68) 7 21.9% Other HrHPV Group B (31/33/35/52/58) 4 12.5% Coinfection: HPV 16+Group B 3 9.4% Coinfection: HPV 16+Group A 1 3.1% Coinfection: Groups A+B 1 3.1% HPV 18/45 (Single Infection) 1 3.1% Triple Coinfection: HPV 18/45+Group A+B 1 3.1% Total 32 100%