HPV burden in Armenia among unvaccinated women: a series of cross-sectional population-based prevalence surveys

Background

In 2017, Armenia introduced a national human papillomavirus (HPV) vaccination programme with a quadrivalent vaccine at age 14 years. Successful implementation of the programme was affected by social media campaigns aiming to discredit its efficacy and safety, the COVID-19 pandemic, and local armed conflicts. To support national public health stakeholders, we initiated a series of studies to provide local evidence on the burden of HPV infection.

Methods

Two cross-sectional HPV prevalence surveys among unvaccinated birth-cohorts of women were conducted: a urine-based survey (UBS) targeted women aged 17–21 years, and a cell-based survey (CBS) targeted women aged 21–39 years. In addition, we collected a series of invasive cervical cancer (CC) case laboratory samples to assess the attributable proportion of high-risk (HR) HPV types to estimate the impact of HPV vaccination in Armenia.

Findings

In the UBS and the CBS, 2485 and 3017 women were included, respectively. In the UBS, 110 (4.5 %) women were positive for any HPV type, 72 (2.9 %) of which were HR HPV and 29 (1.2 %) were HPV16/18. In the CBS, 553 (18 %) were positive for any HPV type, 326 (11 %) of which were HR HPV, and 99 (3.3 %) were HPV16/18. In the CC series, HPV16/18 accounted for 71 % of all HR HPV infections, HPV 31, 33, 45, 52, and 58 accounted for an extra 18 %. The remaining HR types accounted for 11 % of all CC infected by HR HPV. The corresponding predicted cumulative 10-year CC incidence among 20–24, 25–34, and 35–44-year age group, was 0.3 %, 1.3 %, and 3.8 %, respectively.

Interpretation

Our findings provide a picture of the HPV infection and future cervical cancer burden among unvaccinated young and adult women in urban areas of Armenia and can inform context-specific vaccination and screening policies.