Human papillomavirus infection patterns in Harare City clinics, Zimbabwe: a laboratory-based cross-sectional study

¹Harare City Health Department, Harare, Zimbabwe

^&Corresponding author
Emmaculate Govore, Harare City Health Department, Harare, Zimbabwe

Introduction    

Human papillomavirus (HPV) is a common sexually transmitted infection, with almost all sexually active people becoming infected at some point in their lives [1]. It is a public health concern due to its strong association with anogenital malignancies. The virus is responsible for over 600,000 new cervical cancer cases annually [1], with sub-Saharan Africa among those bearing the highest burden of cervical cancer incidence and mortality [2]. Cervical cancer is the leading cancer among women in Zimbabwe. Approximately 3,043 women are diagnosed, and about 1,976 succumb to the disease annually [3].

More than 200 HPV genotypes have been identified, at least 14 of which are classified as high risk by the World Health Organization [2]. In Zimbabwe, the most frequent high-risk HPV genotypes from cervical sites include 16, 18, 33, 35, 45, 56, and 58, whilst from the anal region, HPV 16, 18, 35, 52, and 58 [4]. Approximately 83% of cervical cancers in Zimbabwe are caused by HPV 16 and 18 [4]. Zimbabwe introduced HPV vaccination in 2018 targeting girls aged 10 - 14 years. Several studies have reported high HPV prevalence among people living with HIV compared to those living without HIV [5-7].

There is limited HPV surveillance in Zimbabwe. Laboratory Information Systems (LIS) provide large, routinely collected datasets that can enhance HPV surveillance by monitoring genotype distribution, vaccine impact, and demographic patterns, though limitations such as incomplete clinical data and selection bias remain.

Methods     

Study design and setting: a descriptive cross sectional study using routinely collected laboratory data was conducted. Data were collected from City of Harare clinic laboratories that perform HPV DNA testing.

Study population: the study population comprised women whose samples were tested for HPV using a DNA polymerase chain reaction (PCR) assay at Harare City clinics.

Sample size and sampling techniques: all individuals whose samples were tested for HPV between 1^st October, 2025 and 31^st April, 2026 were purposively selected.

Data collection and tools: data was extracted from LIS and registers using a data abstraction form, anonymized, and stored securely.

Data analysis: quantitative data were analysed using Epi Info version 7. 2.6. Medians and proportions were generated.

Results     

Study population: a total of 4,787 HPV DNA Polymerase Chain Reaction (PCR) test results from six Harare City clinics were analysed. The largest proportion of samples originated from Glen View (24.6%), followed by Mabvuku (23.2%), Tariro (19.4%), Mbare (19.1%), Kuwadzana (9.3%), and Rujeko (4.4%). The clinics served a wide catchment area including Harare's high- and low-density suburbs, surrounding peri-urban settlements, farms, and neighbouring towns. All participants were women aged 16-65 years, with a median age of 39 years (IQR: 33-45) (Table 1).

Human immunodeficiency virus and HIV status: overall HPV prevalence was 26.5% (1,269/4,787), while 73.5% (3,518) tested negative. HIV infection was recorded among both HPV-negative and HPV-positive women. Among HPV-positive women, 1,217 (95.9%) were HIV-positive, and 52 (4.1%) were HIV-negative (Table 1).

Geographic distribution of HPV positivity: HPV positivity varied across residential areas. The highest positivity rates were observed in Churu Farm (40%) and Paddocks (33%). Among urban communities, positivity was highest in Mbare (32%), Eastview (30%), Hopley (27%), Ushewokunze (25%), and Glen View (25%). Lower positivity rates were observed in Kuwadzana and Mabvuku (21% each).

Distribution of HPV genotypes by age group and HIV status: Table 2 summarizes the distribution of HPV genotypes among HPV-positive women according to age group and HIV status. HPV16 and HPV18 were the predominant genotypes across most age groups in both HIV-positive and HIV-negative women. Among HIV-positive women, the highest burden of HPV infection occurred in the 35-44-year age group, accounting for 69.4% of infections. Similarly, among HIV-negative women, 48.1% of HPV infections were detected in women aged 35-44 years. In contrast, among women aged 15-24 years, non-16/18 HPV genotypes predominated, while HPV16 and HPV18 were infrequently detected.

Discussion     

This study provides important insights into HPV epidemiology in Harare City. The HPV positivity rate of 26.5% aligns with regional estimates for sub Saharan Africa. The extremely high HIV-HPV coinfection burden- HPV-positive, HIV-positive: 1217 (95.9%) - reinforces evidence that HIV increases susceptibility to HPV acquisition and persistence. This finding highlights the need for integrated HPV screening within HIV care platforms.

High risk HPV16 and HPV18 dominated genotype distribution, particularly among women aged 35-44 years, where "847 (69.4%)" of HIV positive HPV infected women carried these types. This mirrors global trends and underscores the continued relevance of vaccines targeting HPV16/18. The low detection of HPV16/18 among younger women, where "other" types predominated, may suggest early benefits of Zimbabwe's HPV vaccination programme introduced in 2018, although vaccination status was not available.

The study demonstrates the utility of Laboratory Information Systems (LIS) for HPV surveillance. LIS platforms allow real time monitoring of genotype distribution and demographic patterns. However, limitations such as missing clinical information, lack of vaccination data, and potential selection bias must be addressed to optimize surveillance quality.

Geographical variation in HPV positivity suggests that socioeconomic factors and healthcare access may influence infection patterns. These findings can guide targeted screening and vaccination outreach. Further studies are needed to explore the demographic, behavioural, socioeconomic, and health-system factors underlying these geographic differences and to assess their implications for HPV transmission and cervical cancer prevention.

Overall, the study reinforces the need for sustained HPV vaccination coverage, expanded screening among women living with HIV, and strengthened surveillance systems to monitor genotype trends and vaccine impact.

Conclusion     

Human immunodeficiency virus prevalence remains high in Harare City, particularly among women living with HIV. HPV16 and HPV18 continue to dominate genotype distribution. Strengthening HPV vaccination coverage, integrating HPV screening within HIV services, and enhancing laboratory-based surveillance systems are critical strategies for reducing the burden of cervical cancer in Zimbabwe.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

Emmaculate Govore, Colleen Madembo, and Prosper Chonzi: concept, design, acquisition of data, analysis and interpretation of data, drafting the manuscript, critical evaluation, final approval and guarantor. All the authors read and approved the final version of this manuscript.

Acknowledgments     

We would like to acknowledge our sample collectors- the clinicians and laboratory data loggers - microscopists, without them we would not have been able to carry out the study.

Tables     

Table 1: demographic and clinical characteristics of women tested for human papillomavirus in Harare City clinics, October 2025-April 2026 (N=4,787)

Table 2: distribution of human papillomavirus genotypes among human papillomavirus-positive women by age group and human immunodeficiency virus status, Harare City, Zimbabwe, October 2025-April 2026

References