Prevalence, Genotype Distribution, and Determinants of High-Risk Carcinogenic Human Papillomavirus Infection Among Female Sex Workers in Kilimanjaro Region: A Community-Based Cross-Sectional Study.

ABSTRACT Background: High risk carcinogenic human papillomavirus (hrHPV) is the leading cause of cervical cancer globally. Female sex workers (FSWs) are particularly vulnerable due to high risk sexual behaviors and low cervical cancer screening uptake. Despite their elevated risk, the prevalence, genotype distribution, and determinants of hrHPV infection among this population in Tanzania remain unknown. Hence this study. Methods: A community based cross sectional study was conducted in Kilimanjaro region between June and July 2024, among 309 FSWs aged 25 to 49 years with no history of precancerous lesions or total hysterectomy. The Respondent Driven Sampling (RDS) technique was used to recruit this hard to reach population. Self collected vaginal samples were tested using the ScreenFire HPV assay, detecting 13 genotypes grouped into four risk channels. Data were analysed using SPSS Version 27.0, and a modified Poisson regression with robust error variance was applied to estimate associations between predictor variables and hrHPV infection. Statistical significance was set at p < 0.05. Results: Among the 309 FSWs, the mean age was 36.1 years (SD = 5.243), with nearly half (48.5%) aged 25 to 34 years. The overall hrHPV prevalence was 57.6%, with higher rates among FSWs aged 40 to 44 years (58.5%), HIV positive individuals (90.0%), tobacco smokers (76.8%), and those with prior cervical cancer screening (76.5%). Channel specific hrHPV prevalence was highest for HPV31/33/35/52/58 (23.3%), followed by HPV39/51/56/59/68 (13.6%), HPV16 (9.7%), and HPV18/45 (5.5%). Mixed infections accounted for 5.5%. Religion (APR: 1.45, 95% CI: 1.13 to 1.61), occupation (APR: 1.28, 95% CI: 1.15 to 1.45), HIV status (APR: 1.27, 95% CI: 1.12 to 1.43), tobacco smoking (APR: 1.15, 95% CI: 1.04 to 1.28), and cervical cancer screening history (APR: 0.83, 95% CI: 0.73 to 0.94) were significantly associated with hrHPV infection in this population. Conclusion: This study reveals a high prevalence of hrHPV among FSWs in Kilimanjaro, Tanzania, highlighting the urgent need for targeted cervical cancer prevention interventions for this population. Keywords: Female sex workers, Human papillomavirus, Cervical cancer, Genotype, Kilimanjaro.