Age-Specific Distribution and Factors Associated with High-Risk HPV Infection and Cervical Lesions Among HIV-Positive and -Negative Women in Maputo, Mozambique: Findings from the HPV-ISI Study (2021–2022)

Background/Objective: High-risk Human papillomavirus (hrHPV) is the leading cause of premalignant lesions and cervical cancer (CC), affecting disproportionally women living with HIV. Mozambique is among the countries with a heavy triple-burden of HIV, hrHPV infections and CC which accounts for more than 5300 new cases and 3800 deaths each year. In this study, we assessed the age-specific distribution and factors associated with hrHPV and cervical lesions among HIV-positive and -negative women from HPV-ISI (HPV Innovative Screening Initiative) study in Maputo, Mozambique. Methods: This cross-sectional study included 1,248 non-pregnant women aged ≥18 years who attended CC screening at the DREAM Sant’Egídio Health Center between July 2021 and April 2022. Screening involved visual inspection with acetic acid (VIA) and high-risk HPV DNA testing. Sociodemographic, lifestyle, and reproductive data were collected through a routine questionnaire. Logistic regression assessed associations between risk factors and hrHPV infection or cervical lesions. Age-specific hrHPV prevalence, partial HPV16/18 genotyping, and abnormal cytology rates were further analyzed by HIV status. Results: The mean age was 43.0±8.6 years. The hrHPV prevalence was 28%, higher in HIV-positive (46.8%) than HIV-negative (23.8%) women. Non-16/18 hrHPV types predominated across all ages. VIA positivity was 11.1%, mostly involving <75% cervical area, and was more frequent in younger (30–45 years) and HIV-positive women. Older age (OR 0.98, 95% CI 0.97–1.00, p=0.017) and higher parity (≥3 vs nulliparous: OR 0.58, 95% CI 0.36–0.94, p=0.029) showed protective effects against hrHPV infection. Contraceptive use (OR 1.65, 95% CI 1.15–2.38, p=0.007) and partially/non-visible SCJ (OR 2.88, 95% CI 1.74–4.79, p<0.001) were associated with VIA positivity. Conclusions: hrHPV infection and cervical lesions were more frequent in younger and HIV-positive women, highlighting the need for strengthened targeted screening within HIV care services in Mozambique.