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Published on: March 8, 2012
Developing, Validating, and Testing Non-vaccine-Preventable Human Papillomavirus to Control for Differences in Sexual
Emily Dema1,2, Jaimie Z Shing3, Marta Checchi2
1Institute for Global Health, University College London, London, United Kingdom.
Background:
Evaluating the impact/effectiveness of human papillomavirus (HPV) vaccination generally assumes stability in factors driving transmission, which might not be valid. We aimed to develop, validate, and test a grouping of non-vaccine-preventable HPV (NVP-HPV) types as a molecular indicator associated with sexual behaviors to control for changes in HPV transmission risk.
Methods:
We used data from the National Surveys of Sexual Attitudes and Lifestyles (Natsal-2, 1999-2001, N = 1,849; Natsal-3, 2010-2012, N = 2,407) to validate the association of NVP-HPV (26/53/66/70/73) with self-reported sexual behaviors. We calculated NVP-HPV-adjusted HPV16/18 vaccine impact/effectiveness estimates in two real-world scenarios: Natsal-2/Natsal-3 (sexually experienced women in Britain, 18-44 years), and England's HPV surveillance (women, 16-24 years; 2008, N = 3,539; 2010-2020, N = 24,707). Samples (urine/vulvovaginal swabs) were tested for 21 HPV genotypes (6/11/16/18/26/31/33/35/39/45/51/52/53/56/58/59/66/68/70/73/82) using an in-house multiplex PCR and Luminex-based genotyping assay.
Results:
NVP-HPV infection was strongly associated with sexual behaviors (e.g., younger age at sexual debut and numbers of partners). In Natsal data, adjusting for NVP-HPV did not change vaccine impact estimates [unadjusted prevalence ratio (PR): 0.50 (0.27-0.95) and adjusted PR: 0.45 (0.25-0.82)]. In the second scenario, adjusting for NVP-HPV did not change the PR for HPV 16/18 when comparing 2020 with 2010 [0.07 (0.03-0.15), unadjusted and adjusted PR]. In both scenarios, the prevalence of NVP-HPV did not change over time.
Conclusions:
We have demonstrated proof of concept that NVP-HPV is strongly associated with sexual behaviors. Adjusting for NVP-HPV in two datasets found that the original estimates were robust.
Impact:
NVP-HPV might be used to control for changes in HPV transmission risk over time and between groups when evaluating vaccination impact/effectiveness.
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