Genotypic distribution of high-risk human papillomavirus infections among HIV-negative women in Kigali-Rwanda: a cross-sectional study using Ampfire HPV genotype assay

Abstract

Background: Cervical cancer remains the leading cause of cancer-related morbidity and mortality among women in Rwanda, despite a successful rollout of a national human papillomavirus (HPV) vaccination program in 2011. Understanding the distribution of high-risk human papillomavirus (hrHPV) genotypes in the post-vaccination era is critical for improving screening and prevention strategies. Objective: This study aimed to determine the prevalence and distribution of high-risk human papillomavirus genotypes and their association with HPV vaccination status among HIVnegative women in Kigali. Methods: A cross-sectional study was conducted involving 216 cervicovaginal samples collected from HIV-negative women between 2021-2023. High-risk HPV genotyping was performed using the AmpFire multiplex isothermal amplification assay. Descriptive statistics, Chi-square and Fisher’s exact tests were used to assess genotype-specific prevalence and associations between vaccination status and HPV positivity. Results: The overall hrHPV prevalence was 35.2%, with 13.9% of participants showing multiple hrHPV infections. The prevalence of HPV-16 and HPV-18 was 2.3% and 1.9% respectively. Noncovered-vaccine hrHPV types, particularly HPV-39 (9.3%), HPV-52 (5.6%), and HPV-58 (5.6%), were most frequent. Vaccinated women had significantly lower hrHPV prevalence (29.3%) than unvaccinated (48.5%) (p=0.007). HPV-58 was more prevalent in unvaccinated individuals compared to the unvaccinated (p = 0.032), suggesting possible crossprotection for vaccinated women. Conclusion: The study demonstrates a relatively high prevalence of noncovered-vaccine hrHPV types in HIV-negative women despite high national vaccine coverage. The findings highlight the need for broader vaccine formulations and support the integration of molecular screening tools like AmpFire assay into HPV surveillance in Rwanda.