Prévalence, incidence, persistance et facteurs associés aux infections à virus du papillome humain chez les travailleuses du sexe en Afrique de l’Ouest

Authors: Tounkara, Fatoumata Korika
Advisor: Alary, Michel
Abstract: Female sex workers (FWs) represent a high-risk group for sexually transmitted infections (STIs), including the human immunodeficiency virus (HIV), and the human papillomavirus (HPV). To our knowledge, since 2009, no study has been conducted on the epidemiology of HIV/STIs among FSWs in Mali. Also, there are no available data on the epidemiology of HPV infections in this key population in Mali and Benin.The objectives of this thesis were to (1) assess the prevalence of HIV/STIs and associated factors among FSWs in Bamako, Mali; (2) estimate HPV prevalence, distribution and factors associated with high-risk (HR) HPV infections in FSWs in Bamako (Mali) and Cotonou (Benin), and (3) estimate the incidence and persistence rates of HPV infections in FSWs in the two countries as well as factors related to both incidence and persistence of HR-HPV infections. Cross sectional studies were conducted for objectives 1 and 2, where as a longitudinal study with visits at three time points (baseline, follow-up visits at 6 months and at 12 months) were carried out for objective 3. It took place in Cotonou (Benin) and Bamako (Mali). Sociodemographic, behavioral and gynecological history data were collected. Descriptive statistics were computed. Multivariate log-binomial and Poisson regression models were used to identify factors associated with study outcomes. Overall, 353 FSWs were recruited in Mali; the mean age was 26.8 years. Concerning objective 1, HIV prevalence was 20.4% and 35.1% of FSWs had at least one STI. Factors significantly associated with HIV were older age (trend test, p < 0.0001), sex work duration ≥ 6 years, uneducated status, gonococcal and chlamydial infections (p < 0.05). In addition, younger age (trend test, p = 0.018), number of clients ≥10 during the past week, and HIV infection were significantly associated with other STIs (p < 0.05). Regarding objective 2, HPV data were available for 659 FSWs (309 in Benin and 350 in Mali). The overall HPV prevalence rates were 95.5% in Benin and 81.4% in Mali. The three most common HPV types among FSWs in Benin were HPV58, HPV16, and HPV52; this order was HPV16, HPV51, and HPV52 in Mali. In Benin, the main factors associated with HR-HPV infections were vaginal douching and gonococcal infection (p < 0.05), whereas in Mali, these factors were duration of sex work < 1 year and HIV infection (p < 0.05). Concerning objective 3, the 12-month participation rate was 51.6%, but retention for at least one follow-up visit was 68.6% (51 women not attending the 6-month follow-up visit came back at 12 months). The highest incidence rates of HR-HPV over 12 months occurred with HPV59, HPV16 and HPV35 (≥ 6.3 cases per 1000 women-months). Factors associated with HR-HPV incidence were sex work duration ≤ 1 year and HIV infection (p < 0.05). The highest HR-HPV persistence rates were observed for HPV59, HPV51/HPV52 and HPV35 (≥ 28.6%). Risk factors for HR-HPV persistence were age < 20 years or ≥ 50 years (p < 0.05); HIV and chlamydial infections as well as infection with multiple HPV types at baseline (p <0.05). In conclusion, FSWs in these West African countries are characterized by high HIV/STI prevalence, and by high rates of HPV prevalence, incidence and persistence. These data suggest the need to reconsider the conceptual framework of STI/HIV (including HPV) prevention programs aimed at FSWs in order to prevent cervical cancer among them and break the transmission chain of these STIs to the general population.
Document Type: Thèse de doctorat
Issue Date: 2021
Open Access Date: 2 February 2021
Grantor: Université Laval
Collection:Thèses et mémoires

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