{
  "abstract": "Objectives This study aimed to determine the prevalence of cervical high-risk human papillomavirus (hrHPV) in a community-based setting and its risk factors association in women living in hard-to-reach areas in Bangladesh.Design A cross-sectional studySetting The study was carried out in six subdistricts, located in hard-to-reach and climate-impacted regions of Bangladesh.Participants A total of 8000 married women aged 30–60 years were invited for screening. Women who were unable to give consent, were pregnant or had a hysterectomy with removal of the cervix, previous screening less than 5 years, or treatment of the cervix or had symptoms of potential cervical cancer were excluded.Interventions A community-based hrHPV self-collected screening for cervical cancer was conducted from June 2022 to July 2023.Main outcome measures Prevalence of cervical hrHPV and risk factor association.Results 11 127 women were eligible for screening; 7850 women submitted hrHPV self-swabs, 7828 valid HPV test results were reported and 164 women (2.1%) tested hrHPV positive. Women living in the North were 2.1 times more likely to be hrHPV positive compared with women living in the South (adjusted OR (AOR)=2.1, 95% CI: 1.5 to 3.8, p=0.023) and widowed women were 3.0 times more likely to be hrHPV positive than married women (AOR=3.0, 95% CI: 1.7 to 5.3, p=0.001). Another risk factor associated with testing hrHPV positive was the use of hormonal contraceptives for 5 years and above (AOR=7.0, 95% CI: 2.0 to 24.4, p=0.002).Conclusion The study identified a low overall prevalence of hrHPV infection (2.1%) among women in hard-to-reach areas in Bangladesh, with some regional variations. Higher prevalence was observed in widowed compared with married women and among women reporting more than 5 years of hormonal contraceptive use. This study shows no evidence of particularly high-risk groups in hard-to-reach areas in Bangladesh. The findings support the feasibility of implementing a nationwide hr-HPV-based self-sampling strategy as a viable approach to reach WHO targets for reducing the burden of cervical cancer. Recommendation for policymakers to support future research to identify hrHPV prevalence among women in comparable groups in other geographically remote areas in Bangladesh.Trial registration number NCT05234112.",
  "authors": [
    {
      "affiliations": [
        "Health Sector, Friendship NGO, Dhaka, Bangladesh"
      ],
      "name": "Naheed Nazrul"
    },
    {
      "affiliations": [
        "Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Dhaka, Dhaka District, Bangladesh"
      ],
      "name": "Aminur Rahman"
    },
    {
      "affiliations": [
        "Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands"
      ],
      "name": "Marlieke de Fouw"
    },
    {
      "affiliations": [
        "Usher Institute, University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Christine Campbell"
    },
    {
      "affiliations": [
        "Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands"
      ],
      "name": "Jaap Koot"
    },
    {
      "affiliations": [
        "Health Sector, Friendship NGO, Dhaka, Bangladesh"
      ],
      "name": "Mosamat Umma Kulsum"
    },
    {
      "affiliations": [
        "Health Sector, Friendship NGO, Dhaka, Bangladesh"
      ],
      "name": "MD Shahnur Ahmed"
    },
    {
      "affiliations": [
        "Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"
      ],
      "name": "Shams Shabab Haider"
    },
    {
      "affiliations": [
        "Health Sector, Friendship NGO, Dhaka, Bangladesh"
      ],
      "name": "Md Awlad Hossain"
    },
    {
      "affiliations": [
        "Department of Development Studies, University of Dhaka, Dhaka, Bangladesh"
      ],
      "name": "Kazi Maruful Islam"
    },
    {
      "affiliations": [
        "Gynaecological Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh"
      ],
      "name": "Ashrafun Nessa"
    },
    {
      "affiliations": [
        "Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Dhaka, Dhaka District, Bangladesh"
      ],
      "name": "Miftahuzzannat Amrin"
    },
    {
      "affiliations": [
        "Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands",
        "Department of Obstetrics and Gynaecology, Medisch Centrum Leeuwarden, Leeuwarden, Fryslân, The Netherlands"
      ],
      "name": "Jelle Stekelenburg"
    },
    {
      "affiliations": [
        "Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands"
      ],
      "name": "Jogchum Jan Beltman"
    }
  ],
  "title": "Cervical high-risk human papillomavirus infection and its associated risk factors: a community-based cross-sectional study in hard-to-reach areas in Bangladesh",
  "uid": "5c698974-39bf-59a3-a715-34460d26b56a"
}