(P159) Prevalence And Incidence of Human Papillomavirus Infection Among African Women Randomized to Depot Medroxyprogesterone Acetate, Copper Intrauterine Device, or Levonorgestrel Implant for Contraception

Background: Women in Sub-Saharan Africa bear a disproportionate burden of sexual and reproductive health morbidities, including high rates of vaccine-preventable human papillomavirus (HPV) infection and unintended pregnancies. Hormonal contraceptives may influence the vaginal ecosystem. We thus investigated the possible linkage between HPV incidence and contraceptive method among women seeking contraception in a randomised trial.

Methods: We assessed HPV acquisition among a subset of HIV-seronegative women, randomized to one of the following contraceptives: intramuscular depot medroxyprogesterone acetate (DMPA-IM), copper intrauterine device (IUD), or subdermal levonorgestrel (LNG) implant as part of The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial, who enrolled into a biomedical sub-study at three sites in Kenya and South Africa. Participants were followed three-monthly for 18 months. At each visit, 18 high-risk and 18 low-risk HPV genotypes in endocervical swab samples were typed using the HPV Direct Flow CHIP Kit.

Results: At baseline, 175/237 (74%) participants (median age 24 years, IQR 20-27) had any HPV: 57% had at least one high-risk HPV genotype, of which HPV52 was the most common (prevalence 13%), followed by HPV16 (10%), HPV18 (9%) and HPV58 (8%). Women who were HPV-negative at baseline acquired any HPV type at an incidence of 0.6 (95% confidence interval [CI] 0.3-1.1) infections per person-year (p-y) among women assigned DMPA-IM, 1.0 (95% CI 0.7-1.6) per p-y for LNG implant users, and 1.4 (95% CI 0.9-2.1) per p-y for copper IUD users. Using intention-to-treat analysis with Poisson regression, incidence of any HPV was statistically higher in women assigned copper IUD relative to DMPA-IM (incidence rate ratio [IRR] of 2.2 (95% CI 1.1-4.6), p=0.02); all other pairwise comparisons were not statistically different. Relative to DMPA-IM, copper IUD also tended to have a higher incidence of high-risk HPV genotypes (IRR 2.0, 95% CI 0.8-4.9, p=0.12).

Conclusion: High-risk HPV genotypes were common in East and southern Africa, thus HPV vaccination campaigns are vital to reduce the risk of HPV acquisition and cervical cancer. Further, in a randomised trial, women assigned to copper IUD had greater incidence of HPV acquisition than women assigned to DMPA-IM, a finding that requires further inquiry.