POP-Brazil study protocol: a nationwide cross-sectional evaluation of the prevalence and genotype distribution of human papillomavirus (HPV) in Brazil

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Abstract

Introduction

Human papillomavirus (HPV) is associated with the development of genital warts and different types of cancer, including virtually all cervical cancers and a considerable number of penile, anal and oropharyngeal cancers. Data regarding the prevalence of HPV infection in Brazil are limited and fragmented. We aim to determine HPV prevalence in sexually active women and men aged 16–25 years and to investigate regional differences in virus prevalence and types.

Methods and analysis

This is a nationwide, multicentric, cross-sectional, prospective study that will include participants aged 16–25 years from all Brazilian capital cities. Recruitment will occur in primary health units by trained health professionals who will be responsible for collecting biological samples and interviewing the volunteers. After signing informed consent, all participants will answer a questionnaire that will collect sociodemographic and behavioural data. All samples will be processed in a certified central laboratory, and strict quality control will be performed by many different procedures, including double data entry, training and certification of primary care health professionals responsible for data collection, simulation of interviews, and auditing and monitoring of visits. The sample size will be standardised based on the population distribution of each capital using SAS and R statistical software.

Ethics and dissemination

The project was approved by the research ethics committee of the main institution and the corresponding ethics committees of the recruitment sites. This will be the first Brazilian nationwide study to determine overall HPV prevalence and to examine regional differences and social, demographic and behavioural factors related to HPV infection. Critical analysis of the study results will contribute to epidemiological knowledge and will set a baseline for future evaluation of the impact of the National HPV Vaccination Program.

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Most cited references 15

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The causal relation between human papillomavirus and cervical cancer.

F X Bosch, A Lorincz, N Muñoz … (2002)

The causal role of human papillomavirus infections in cervical cancer has been documented beyond reasonable doubt. The association is present in virtually all cervical cancer cases worldwide. It is the right time for medical societies and public health regulators to consider this evidence and to define its preventive and clinical implications. A comprehensive review of key studies and results is presented.

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Cervical HPV infection in Brazil: systematic review.

Andréia Ayres, Gulnar Silva (2010)

To assess the prevalence of human papillomavirus (HPV) infection in women in Brazil. A systematic literature review was conducted with an active search in PubMed and Virtual Health Library databases using the terms "human papillomavirus," "HPV," "prevalence," and "Brazil". Of 155 articles retrieved, 82 were selected after reading their title and abstract. After a thorough examination, 14 articles were included in the study. The 14 articles selected were published between 1989 and 2008 and comprised studies from four Brazilian macroregions (Southeast - 43%; South - 21.4%; Northeast - 21.4%; and North - 7.1%). Nine were cross-sectional studies. Eight articles used polymerase chain reaction and seven used hybrid capture for HPV detection. The study samples ranged from 49 to 2,329 women. The overall prevalence of HPV cervical infection was between 13.7% and 54.3%; and women with cytologically normal results had 10% to 24.5% prevalence of HPV cervical infection. Four articles described the most common HPV types. The cytology techniques available use different classifications leading to different HPV prevalence estimates. However, considering the studies individually according to the detection technique used, the HPV prevalence has increased. HPV16 was the most prevalent type among women, regardless of the cytology result. The concentration of studies in the Southeast region, especially in metropolitan regions, evidences that further investigations are needed to improve information coverage of Brazilian women.

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Prevalence, incidence, and estimated life-time risk of cervical human papillomavirus infections in a nonselected Finnish female population.

K. Syrjänen, M Hakama, S Saarikoski … (1990)

The authors derived prevalence and incidence figures for cervical human papillomavirus (HPV) infections in an unselected Finnish population of women aged 22. This paper is an epidemiologic study utilizing the mass-screening program that has been conducted in Finland for cervical cancer since the early 1960s. The authors estimated the lifetime risk of cervical HPV infections based on the figures in this program and on those derived from a random sample of 2,084 (out of 28,861) routine Papanicolaou (Pap) smears examined in their laboratory. The mass-screening program was performed between 1985-1986 focusing on a total cohort of 22-year-old women (born in 1963) in Kuopio province. In 1985, 2,013 women were invited of which 1,289 attended. One year later, 1,768 women of those 2,013 were reinvited, and the number of women screened at the second round was 1,069. The routine cervicovaginal Pap smears were taken, including a cell sample from the vagina, exocervix, and endocervix. All smears were screened for the HPV-induced cytopathic changes by the same cytopathologist. The prevalence of HPV infection among the 22-year-old women was about 3% at the beginning of the follow-up and about 7% one year later. The crude annual incidence was 7.0%. According to the estimates for the life-time risk, half of the sexually active women would experience at least one HPV infection within 10 years. Up to 79% of the Finnish females would contract at least one HPV infection between ages 20 and 79 years. This indicates that factors, which are poorly understood at the moment, exist that regulate the development of an invasive carcinoma from a CIS lesion.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2018

Publication date (Electronic): 7 June 2018

Volume: 8

Issue: 6

Electronic Location Identifier: e021170

Affiliations

[1 ] Hospital Moinhos de Vento , Porto Alegre, Brazil

[2 ] departmentCommunity Health Department , Federal University of Health Science of Porto Alegre , Porto Alegre, Brazil

[3 ] departmentNational Immunization Program , Brazilian Ministry of Health , Brasília, Brazil

[4 ] departmentDepartment of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis , Brazilian Ministry of Health , Brasília, Brazil

[5 ] departmentNational Institute for Health Technology Assessment , Federal University of Rio Grande do Sul , Porto Alegre, Brazil

[6 ] departmentDepartment of Preventive and Social Odontology , Federal University of Rio Grande do Sul , Porto Alegre, Brazil

[7 ] Universidade de São Paulo and Instituto do Cancer do Estado de São Paulo (ICESP) , Sao Paulo, Brazil

Author notes

[Correspondence to ] Dr Eliana Marcia Wendland; eliana.wendland@ 123456hmv.org.br

Article

Publisher ID: bmjopen-2017-021170

DOI: 10.1136/bmjopen-2017-021170

PMC ID: 6009568

PubMed ID: 29880568

SO-VID: 8d1215c4-cb2c-4932-b518-21e46f0cd798

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 15 December 2017

Date revision received : 24 April 2018

Date accepted : 04 May 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100006506, Ministério da Saúde;

Funded by: Pan-American Health Organization;

Funded by: Moinhos de Vento Hospital;

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ScienceOpen disciplines: Medicine

Keywords: nationwide study,hpv infection,anogenital,prevalence,brazil

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ScienceOpen disciplines: Medicine

Keywords: nationwide study, hpv infection, anogenital, prevalence, brazil

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