Epidemiology of HPV Infection and Feasibility of an HPV Vaccine in Haiti

Friday, 14 February 2014
Toronto (Hyatt Regency Chicago)
Cynthia Rivière , GHESKIO Centers, Port-au-Prince, Haiti
Introduction:  Cervical cancer, caused by HPV infection, is responsible for half of all cancer deaths in Haitian women. Early detection and treatment linked with an HPV vaccination program are necessary to address this health crisis. 

 Objectives: To determine the feasibility of initiating an HPV vaccination program in Haiti.  

Methodology:  This study was conducted at Les Centres GHESKIO in Port-au-Prince, Haiti and aimed at determining  1) The importance of HPV/cervical disease and its clinical course over one year in 206 HIV non-infected commercial sex workers (CSWs) 18-30 years old using HPV testing, colposcopy guided biopsy and Pap test 2) knowledge , attitude and practices (KAP) regarding HPV,  cervical cancer and HPV vaccination of the general public, at risk patients, parents  as well as community and political leaders through structured questionnaires,   focus groups and workshops. 
Results:  1) The prevalence of high-risk HPV infection in CSWs was 35.5% at baseline and 37.0% at one year. The main circulating subtypes at entry  were HPV 58 (15%), HPV 16 (11%), HPV 35 (11%), HPV 18 (10%), HPV 51 (10%), HPV 68 (10%), HPV 45 (9%), and HPV 31 (8%) 2) Of 206 CSWs tested  2.5% had high grade lesions (HSIL, CIN2+) at entry 3) Over 2,500 persons were interviewed including 206 CSWs, 200 HIV-infected young adults and leaders and members of the community at large: 60% had heard of cervical cancer and 17% of HPV. Lower level of knowledge was found in CSWs and HIV-infected young adults:  36% of CSWs and 21% HIV-infected young adults evaluated had heard of cervical cancer, 8% and 7% respectively had heard of HPV.   Although only 9% of the population had heard about HPV vaccine, a majority would accept to be vaccinated and to vaccinate their daughters (79% and 81% respectively). 4) Community and political leaders were in favor of early detection and HPV vaccination. Information collected through this study has been shared with the Haitian Ministry of Health who is now committed to move forward with an HPV vaccination program. 
Conclusion:  This study documents the importance of HPV, the major HPV subtypes and cervical disease in a population of CSWs in Haiti as well as the lack of information on HPV particularly among high risk populations, and the large acceptation of HPV vaccination.  It highlights the need for widespread information and education to prevent HPV and cervical cancer through the initiation of an HPV vaccination program.