Adolescent girls’ perception about their ability to safely offer HIV self-test kits to sexual partners: a feasibility study in Siaya County, Kenya

Background: Adolescent girls (AG) in sub-Saharan Africa are at elevated risk of acquiring HIV, yet few know the HIV status of their sexual partners. Interventions to promote testing among partners are urgently needed. Objectives: To explore AG’s perceived ability to safely distribute HIV self-tests to their partners, if partners would self-test, and how to minimize partner violence. Methods: We recruited HIV-negative AG ages 15-19 years with a partner of unknown HIV status or who tested negative >6 months previously. Using mixed-methods for data collection and regression and inductive thematic analysis for quantitative and qualitative analysis, respectively, we determined factors associated with the study objectives. Results: We enrolled 101 AG, median age 17.3 years, sexual debut 15-16 years, and 54.5% reported ≥2 lifetime partners. Most participants (95.0%) would offer self-tests to their partners and 95.1% reported high-to-moderate chance their part- ner would self-test. No participant attribute was associated with perceived ability to offer self-test or likelihood of partner testing. To avoid violence, AG recommended politeness, indirect approach, voluntariness, and highlighting advantages of self-testing. Conclusions: AG believe they can safely distribute self-tests to their partners, and most partners would self-test, expanding utility of HIV self-tests to include partners of AG. Keywords: HIV self-testing; partner testing; couples testing; adolescent girls; Kenya.

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Feasibility of Indirect Secondary Distribution of HIV Self-Test Kits via WeChat Among Men Who Have Sex with Men: A National Cross-Sectional Study in China (Preprint)

10.2196/preprints.28508 ◽

2021 ◽

Author(s):

Li Shangcao ◽

Jing Zhang ◽

Xiang Mao ◽

Tianyi Lu ◽

Yangyang Gao ◽

...

Keyword(s):

Social Media ◽

Online Survey ◽

Sexual Partners ◽

Cross Sectional ◽

Self Testing ◽

Hiv Test ◽

Condomless Anal Intercourse ◽

Secondary Distribution ◽

Self Test ◽

Sex With Men

BACKGROUND The use of HIV self-test (HST) kits is commonplace in key sexually active populations. The direct secondary distribution of HST kits (DSDHK) is effective in improving the uptake of HIV self-testing. However, there are concerns about various limitations of DSDHK, including limited geographic location, payment problems, and face-to-face interaction. OBJECTIVE We evaluated the feasibility and characteristics of the indirect secondary distribution of HST kits (ISDHK) via WeChat (distributing HST application links and follow-up HST kits to partners) among men who have sex with men (MSM). METHODS From October 2017 to September 2019, an HIV self-testing (HIVST) recruitment advertisement was disseminated on the WeChat social media platform to invite MSM to apply for HST kits (referred to as “index participants” [Ips]). All of the MSM participants were encouraged to distribute the HST application link to their friends and sexual partners (referred to as “Alters”) through their social networks. All Alters were further encouraged to continue to distribute the HST application link. All participants paid a deposit (USD 7), refundable upon completion of the questionnaire and uploading of the test result via an online survey system. RESULTS 2,263 MSM met the criteria and successfully applied for HST. Of these, 1,816 participants returned their HST test results, including 1,422 (88.3%) IPs and 394 (21.7%) Alters. Compared with the IPs, the Alters practiced more condomless anal intercourse (CAI), a higher proportion of them never previously had an HIV test, and they had a greater willingness to distribute HST kits to sexual partners (all p < 0.05). After controlling for age, education, and income, the Alters had a greater proportion of MSM who had never tested for HIV before (aOR = 1.29, 95% CI 1.00–1.68), were more willing to distribute the HST application link (aOR = 1.71, 95% CI 1.21–2.40), had a lower number of sexual partners (aOR = 0.71, 95% CI 0.57–0.90), and were less likely to search for sexual partners via online means (aOR = 0.78, 95% CI 0.60–1.02). In comparison, the rates of reactive HST results, conducting HIV confirmatory tests, HIV seropositivity, and initiation of HIV antiretroviral therapy (ART) were similar for IPs and Alters. CONCLUSIONS The ISDHK mode of distributing HST application links via social media is feasible among the MSM population. The ISDHK mode should be used to supplement the DSDHK mode in order to enable a greater proportion of the MSM population to know their HIV infection status.

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A systematic review of qualitative evidence on factors enabling and deterring uptake of HIV self-testing in Africa

BMC Public Health ◽

10.1186/s12889-019-7685-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 13

Author(s):

Bernard Njau ◽

Christopher Covin ◽

Esther Lisasi ◽

Damian Damian ◽

Declare Mushi ◽

...

Keyword(s):

Systematic Review ◽

Hiv Testing ◽

Linkage To Care ◽

Ease Of Use ◽

Sub Saharan Africa ◽

Care Providers ◽

African Countries ◽

Qualitative Evidence ◽

Self Testing ◽

Self Test

Abstract Background More than 40% of adults in Sub-Saharan Africa are unaware of their HIV status. HIV self-testing (HIVST) is a novel approach with a potential to increase uptake of HIV testing and linkage to care for people who test HIV positive. We explored HIV stakeholder’s perceptions about factors that enable or deter the uptake of HIV self-testing and experiences of self-testing of adult users in Africa. Methods This systematic review of qualitative evidence included articles on qualitative studies published or made available between January 1998 to February 2018 on perspectives of key stakeholders, including HIV policymakers, HIV experts, health care providers, and adult men and women (18 years and above) about factors that enable or deter the uptake of HIV self-testing and experiences of self-testing among adult users. We searched CINAHL, MEDLINE in Pubmed, EMBASE, AJOL, PsycINFO, Social Science Citation Index (SSCI), and Web of Science for articles in English on HIVST with qualitative data from different African countries. Results In total, 258 papers were retrieved, and only nine (9) studies conducted in 5 African countries were eligible and included in this synthesis. Perceived facilitators of the uptake of HIVST were autonomy and self-empowerment, privacy, confidentiality, convenience, opportunity to test, including couples HIV testing, and ease of use. The perceived barriers included the cost of buying self-test kits, perceived unreliability of test results, low literacy, fear and anxiety of a positive test result, and potential psychological and social harms. HIV stakeholder’s concerns about HIVST included human right issues, lack of linkage to care, lack of face-to-face counseling, lack of regulatory and quality assurance systems, and quality of self-test kits. Actual HIVST users expressed preference of oral-fluid self-testing because of ease of use, and that it is less invasive and painless compared to finger-stick/whole blood-based HIV tests. Lack of clear instructions on how to use self-test kits, and existing different products of HIVST increases rates of user errors. Conclusions Overcoming factors that may deter HIV testing, and HIVST, in particular, is complex and challenging, but it has important implications for HIV stakeholders, HIVST users, and public health in general. Research is warranted to explore the actual practices related to HIVST among different populations in Africa.

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“We are in this together:” dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP

BMC Public Health ◽

10.1186/s12889-021-10707-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Virginia A. Fonner ◽

Jacob Ntogwisangu ◽

Isihaka Hamidu ◽

Juliet Joseph ◽

Joshua Fields ◽

...

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Hiv Infections ◽

Sexual Partners ◽

Sub Saharan Africa ◽

Study Participation ◽

Serodiscordant Couples ◽

Hiv Serodiscordant Couples ◽

Self Testing

Abstract Background A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. This qualitative study was undertaken to understand and describe decision-making and dyadic-level influence among members of serodiscordant couples regarding (1) participation in a dyadic-based research study involving HIV self-testing and access to PrEP, and (2) utilization of PrEP and ART. Methods This qualitative study was nested within an observational cohort study assessing the acceptability of home-based couples’ HIV self-testing and uptake of dyadic care for serodiscordant couples involving facilitated referral for HIV-positive partners and access to PrEP for HIV-negative partners. Semi-structured in-depth interviews were conducted among a subset of study participants (n = 22) as well as individuals involved in serodiscordant relationships who chose not to participate (n = 9). Interviews focused on couples’ decision-making regarding study participation and dyadic-level influence on medication use. Interviews were transcribed verbatim and translated from Kiswahili into English. Data were analyzed using thematic analysis. Results Three major themes were identified: (1) HIV as “two people’s secret” and the elevated role of partner support in serodiscordant relationships; (2) the intersectional role of HIV-status and gender on decision-making; (3) the relational benefits of PrEP, including psychosocial benefits for the couple that extend beyond prevention. Conclusions The study found that couples made joint decisions regarding study participation and uptake of HIV-related medication. Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples.

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HIV Self-Testing to Promote Serostatus Disclosure Among Men Who Have Sex With Men in China: Protocol for a Stepped Wedge Randomized Controlled Trial (Preprint)

10.2196/preprints.17788 ◽

2020 ◽

Author(s):

Tianyi Lu ◽

Hang Li ◽

Xiang Mao ◽

Erlei Peng ◽

Yangyang Gao ◽

...

Keyword(s):

Hiv Testing ◽

Sexual Behaviors ◽

Controlled Trial ◽

Sexual Partners ◽

Hiv Status ◽

Serostatus Disclosure ◽

Self Testing ◽

Hiv Serostatus ◽

Sex With Men

BACKGROUND Disclosure of HIV serostatus is important for the prevention of HIV infection among men who have sex with men (MSM). However, knowledge of sexual partners’ HIV status among MSM in China is low. As a complement to HIV testing services, HIV self-testing (HIVST) has considerable potential to promote serostatus disclosure. OBJECTIVE The primary objective of our trial is to evaluate the effect of HIVST on improving serostatus disclosure to sexual partners. We hypothesize that MSM in an intervention condition will have a higher awareness of the HIV status of their sexual partners compared with MSM in the control condition. The secondary aims are to evaluate (i) changes in sexual behaviors after disclosure of HIV status by sexual partners, (ii) promotion of the frequency of HIV and syphilis testing on participants and their sexual partners, and (iii) factors that restrict the disclosure of HIV infection to sexual partners. We hypothesize that MSM in the intervention condition will exhibit safer sexual decision making and a higher rate of HIV testing uptake compared with MSM in the control condition. METHODS A stepped wedge randomized controlled trial will be conducted throughout China. Study recruitment of 800 MSM will be promoted through advertisements released on WeChat public accounts. Individuals who are born biologically male, aged ≥18 years, HIV negative, and who have not undergone HIV testing in the past 3 months will be recruited. Eligible men will be randomly divided (1:1:1:1) into four groups and randomized. The group cluster will initiate the intervention so that participants will be provided with 2-4 free finger prick–based HIVST kits until trial completion. The intervention period for participants in each of the four groups will be initiated at 3-month intervals. Men in both groups will be required to complete a baseline and four follow-up surveys every 3 months. The primary intervention outcome will evaluate the effect of the distribution of HIVST kits on improvement in the disclosure of sexual partners’ HIV status. The secondary outcomes will be changes in sexual behaviors after disclosure of HIV status from sexual partners, the promotion of the frequency of HIVST on participants and their sexual partners, and the factors that restrict disclosure of HIV status to sexual partners. RESULTS Subject recruitment began in August 2018. The first round of follow-up surveys post intervention is complete, with three rounds remaining to be done. Data analysis was scheduled for April 2020 and the results will be disseminated through conferences and peer-reviewed publications. CONCLUSIONS Few studies have evaluated interventions to increase knowledge of sexual partners’ HIV status among MSM. Our trial will provide information on the link between HIVST and HIV serostatus disclosure. The findings of this trial will facilitate the implementation of HIVST services to help control the spread of HIV among MSM in China. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR1800019453; http://www.chictr.org.cn/showproj.aspx?proj=30158 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17788

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HIV infection and sexual partnerships and behaviour among adolescent girls in Nairobi, Kenya

International Journal of STD & AIDS ◽

10.1258/ijsa.2012.011361 ◽

2012 ◽

Vol 23 (7) ◽

pp. 468-474 ◽

Cited By ~ 18

Author(s):

A F Rositch ◽

P Cherutich ◽

P Brentlinger ◽

J N Kiarie ◽

R Nduati ◽

...

Keyword(s):

Hiv Infection ◽

Hiv Testing ◽

Adolescent Girls ◽

Sexual Debut ◽

Sexual Relationships ◽

Sexual History ◽

Sub Saharan Africa ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Sexual Partnerships

Early sexual partnerships place young women in sub-Saharan Africa at high risk for HIV. Few studies have examined both individual- and partnership-level characteristics of sexual relationships among adolescent girls. A cross-sectional survey of sexual history and partnerships was conducted among 761 adolescent girls aged 15–19 years in Nairobi, Kenya. Rapid HIV testing was conducted and correlates of HIV infection were determined using multivariate logistic regression. The HIV prevalence was 7% and seropositive adolescents had a younger age at sexual debut ( P < 0.01), more sexual partners in 12 months ( P = 0.03), and were more likely to report transactional or non-consensual sex( P < 0.01). Girls who reported not knowing their partner's HIV status were 14 times as likely to be HIV-seropositive than girls who knew their partner's status (adjusted odds ratio: 14.2 [1.8, 109.3]). Public health messages to promote HIV testing and disclosure within partnerships could reduce sexual risk behaviours and HIV transmission among adolescents.

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Operationalizing the distribution of oral HIV self-testing kits to men who have sex with men (MSM) in a highly homophobic environment: The Nigerian experience

10.21203/rs.3.rs-402283/v1 ◽

2021 ◽

Author(s):

Adekemi Sekoni ◽

Waimar Tun ◽

Osasuyi Dirisu ◽

Temitope Ladi-Akinyemi ◽

Elizabeth Shoyemi ◽

...

Keyword(s):

Healthcare Workers ◽

Engagement In Care ◽

Hiv Status ◽

Effective Strategies ◽

Qualitative Survey ◽

Self Testing ◽

Community Skills ◽

Care Health ◽

Self Test ◽

Sex With Men

Abstract Background Self-care health interventions are innovative approaches for improving health and achieving the SDGs. MSM have been disproportionately affected by HIV. In spite of this, stigma from healthcare workers has reportedly prevented MSM from accessing HIV testing in health facilities. This paper explored the operationalization of using KOLs to distribute HIVST kits to MSM.Methods This qualitative survey used a combination of IDI with HIVST users and FGDs with KOLs to collect data three months after distribution of the test kits by the KOLs. Thematic analysis of the data was carried out.Results Three themes were generated namely: KOLs serve as a trusted resource to promote and support HIVST for the MSM community; Skills and qualifications of KOLs required to effectively distribute and promote uptake of HIVST; and Effective strategies used to create demand and promote uptake of HIVST.Conclusions This study showed the practical steps involved in operationalizing KOL support system distribution of HIVST that positively influenced the testing experience for the participants irrespective of the HIV status and engagement in care. KOLs are a reliable resource to leverage on for ensuring that HIV self-test is utilized and positive individuals are linked to treatment and care in homophobic environments.

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The role of food security in increasing adolescent girls’ agency towards sexual risk taking: qualitative findings from an income generating agricultural intervention in southwestern Kenya

BMC Public Health ◽

10.1186/s12889-021-12051-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maricianah A. Onono ◽

Gladys Odhiambo ◽

Lila Sheira ◽

Amy Conroy ◽

Torsten B. Neilands ◽

...

Keyword(s):

Food Insecurity ◽

Sexual Risk ◽

Adolescent Girls ◽

Hiv Risk ◽

Risk Taking ◽

Basic Needs ◽

Sexual Partners ◽

Transactional Sex ◽

Sub Saharan Africa ◽

Sexual Risk Taking

Abstract Background Food insecurity is an important underlying driver of HIV risk and vulnerability among adolescents in sub-Saharan Africa. In this region, adolescents account for 80% of all new HIV infections. The primary purpose of this analysis is to understand perceived mechanisms for how a multisectoral agricultural intervention influenced sexual risk taking among HIV-affected adolescents in southwestern Kenya. Methods We conducted semi-structured, individual interviews with 34 adolescent-caregiver dyads who were participants in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in the Shamba Maisha trial (NCT01548599), a multi-sectoral agricultural and microfinance intervention. Interviews were audiotaped, transcribed, translated, and analyzed using framework and interpretive description analysis methods. Results Adolescents receiving the Shamba Maisha intervention described no longer needing to engage in transactional sex or have multiple concurrent sexual partners as a way to meet their basic needs, including food. Key mechanisms for these effects include greater sexual agency among adolescent girls, and increased confidence and self-efficacy in overcoming existing reciprocity norms and sexual relationship power inequity; as well as staying in school. The intervention also increased caregiver confidence in talking about adolescent sexual reproductive health issues. In contrast, driven primarily by the need for food and basic needs, girls in the control arms described engaging in transactional sex, having multiple sexual partners, being unable to focus in school, getting pregnant or becoming HIV infected. Conclusion These findings emphasize the need to address food insecurity as a part of structural interventions targeting adolescent HIV risk in low-resource countries. We recommend that future interventions build upon the Shamba Maisha model by combining sustainable agricultural production, with household level interventions that deliberately target gender norms that contribute to unequal power dynamics.

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HIV Self-Testing to Promote Serostatus Disclosure Among Men Who Have Sex With Men in China: Protocol for a Stepped Wedge Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/17788 ◽

2020 ◽

Vol 9 (7) ◽

pp. e17788

Author(s):

Tianyi Lu ◽

Hang Li ◽

Xiang Mao ◽

Erlei Peng ◽

Yangyang Gao ◽

...

Keyword(s):

Hiv Testing ◽

Sexual Behaviors ◽

Controlled Trial ◽

Sexual Partners ◽

Hiv Status ◽

Serostatus Disclosure ◽

Self Testing ◽

Hiv Serostatus ◽

Sex With Men

Background Disclosure of HIV serostatus is important for the prevention of HIV infection among men who have sex with men (MSM). However, knowledge of sexual partners’ HIV status among MSM in China is low. As a complement to HIV testing services, HIV self-testing (HIVST) has considerable potential to promote serostatus disclosure. Objective The primary objective of our trial is to evaluate the effect of HIVST on improving serostatus disclosure to sexual partners. We hypothesize that MSM in an intervention condition will have a higher awareness of the HIV status of their sexual partners compared with MSM in the control condition. The secondary aims are to evaluate (i) changes in sexual behaviors after disclosure of HIV status by sexual partners, (ii) promotion of the frequency of HIV and syphilis testing on participants and their sexual partners, and (iii) factors that restrict the disclosure of HIV infection to sexual partners. We hypothesize that MSM in the intervention condition will exhibit safer sexual decision making and a higher rate of HIV testing uptake compared with MSM in the control condition. Methods A stepped wedge randomized controlled trial will be conducted throughout China. Study recruitment of 800 MSM will be promoted through advertisements released on WeChat public accounts. Individuals who are born biologically male, aged ≥18 years, HIV negative, and who have not undergone HIV testing in the past 3 months will be recruited. Eligible men will be randomly divided (1:1:1:1) into four groups and randomized. The group cluster will initiate the intervention so that participants will be provided with 2-4 free finger prick–based HIVST kits until trial completion. The intervention period for participants in each of the four groups will be initiated at 3-month intervals. Men in both groups will be required to complete a baseline and four follow-up surveys every 3 months. The primary intervention outcome will evaluate the effect of the distribution of HIVST kits on improvement in the disclosure of sexual partners’ HIV status. The secondary outcomes will be changes in sexual behaviors after disclosure of HIV status from sexual partners, the promotion of the frequency of HIVST on participants and their sexual partners, and the factors that restrict disclosure of HIV status to sexual partners. Results Subject recruitment began in August 2018. The first round of follow-up surveys post intervention is complete, with three rounds remaining to be done. Data analysis was scheduled for April 2020 and the results will be disseminated through conferences and peer-reviewed publications. Conclusions Few studies have evaluated interventions to increase knowledge of sexual partners’ HIV status among MSM. Our trial will provide information on the link between HIVST and HIV serostatus disclosure. The findings of this trial will facilitate the implementation of HIVST services to help control the spread of HIV among MSM in China. Trial Registration Chinese Clinical Trial Registry ChiCTR1800019453; http://www.chictr.org.cn/showproj.aspx?proj=30158 International Registered Report Identifier (IRRID) DERR1-10.2196/17788

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Uptake of HIV/AIDS Services Following a Positive Self-Test Is Lower in Men Than Women in the Democratic Republic of the Congo

Frontiers in Medicine ◽

10.3389/fmed.2021.667732 ◽

2021 ◽

Vol 8 ◽

Author(s):

Serge Tonen-Wolyec ◽

Charles Kayembe Tshilumba ◽

Salomon Batina-Agasa ◽

Alliance Tagoto Tepungipame ◽

Laurent Bélec

Keyword(s):

Positive Result ◽

Democratic Republic ◽

Secondary Analysis ◽

Linkage To Care ◽

Sub Saharan Africa ◽

Hiv Care ◽

Self Testing ◽

Republic Of The Congo ◽

Self Test ◽

Linkage To Hiv Care

As far as HIV self-testing (HIVST) is concerned, proving the link to HIV care for users with a positive result contributes to understanding the implementation of HIVST. We sought to examine whether there were differences by sex in the uptake of HIV services following a positive self-test in the Democratic Republic of the Congo (DRC). This was a mixed-methods study exploring linkage to care for HIVST through a secondary analysis of collected data from three pilot surveys recently conducted in three cities (Kinshasa, Kisangani, and Kindu) during 2018 and 2020 in the DRC. Linkage to HIV care was defined as delayed when observed beyond 1 week. A total of 1,652 individuals were self-tested for HIV. Overall, the proportion of linkage to HIV care was high (n = 258; 82.2%) among individuals having a positive result with HIV self-test (n = 314), but it was significantly lower in men (65.2%) than women (89.2%). Furthermore, linkage to HIV care of men was significantly delayed as compared with that of women (40.0 vs. 20.7%). These findings show a lower uptake of care following a positive self-test in men than women. This trend already previously observed in sub-Saharan Africa shed light on the need to increase linkages to care among men newly diagnosed through HIV self-testing.

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HPV prevalence around the time of sexual debut in adolescent girls in Tanzania

Sexually Transmitted Infections ◽

10.1136/sextrans-2019-054012 ◽

2019 ◽

Vol 96 (3) ◽

pp. 211-219 ◽

Cited By ~ 3

Author(s):

Kathy J Baisley ◽

Aura Andreasen ◽

Julia Irani ◽

Soori Nnko ◽

John Changalucha ◽

...

Keyword(s):

Cervical Cancer ◽

Y Chromosome ◽

Adolescent Girls ◽

Hpv Vaccine ◽

Sexual Debut ◽

Hpv Infection ◽

Cervical Cancer Prevention ◽

Sub Saharan Africa ◽

Cross Sectional ◽

Hpv Prevalence

ObjectivesCervical cancer is the leading cause of cancer-related mortality among women in sub-Saharan Africa (SSA). Data on human papillomavirus (HPV) epidemiology in adolescent girls in SSA are essential to inform HPV vaccine policy recommendations for cervical cancer prevention. We assessed the burden of HPV infection, and risk factors for infection, among adolescent girls around the time of sexual debut.MethodsCross-sectional study of secondary school girls aged 17–18 years in Tanzania. Consenting participants provided samples for HPV and STI testing. Vaginal swabs were tested for 37 HPV genotypes by Roche Linear Array. Logistic regression was used to identify factors associated with HPV infection. Y chromosome was tested as a marker of recent condomless sex.Results163/385 girls (42.3%) reported previous penetrative sex. HPV was detected in 125/385 (32.5%) girls, including 84/163 (51.5%) girls reporting previous sex and 41/222 (18.5%) reporting no previous sex. High-risk (HR) genotypes were detected in 70/125 (56.0%) girls with HPV infection. The most common HR genotype was HPV-16 (15/385; 3.9%). The prevalence of other HR HPV vaccine genotypes was between 0.8% and 3.1%. Among 186 girls who reported no previous sex, were negative for Y chromosome, and had no STI, 32 (17%) had detectable HPV. Lactobacillus sp and bacterial vaginosis-associated bacteria were negatively and positively associated, respectively, with HPV.ConclusionsHPV prevalence among adolescent girls around the time of sexual debut was high. However, prevalence of most vaccine genotypes was low, indicating that extending the age range of HPV vaccination in this region may be cost-effective.

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