Abstract B69: Cervical and anal HPV serotype-specific prevalence among high-risk indigent women in substance abuse recovery
Authors: Felini Martha J. , Igenoza Oluwatosin , Bangara Saritha , Ukpaka Kelechi , Jegede Opeyemi , Gupta Shuchika , Voskuhl Gene W. , Kremer Timothy , Anderson Ralph , Qualls-Hampton Raquel 
Published: May 2016

Background: A high priority area identified by the President's Cancer Panel is increasing the uptake of human papillomavirus (HPV) vaccinations. One group at highest risk of HPV-related cancers is a hard to reach, underserved, and marginalized population – indigent women who use sex for drug money. Illicit drug users are characteristically at high risk for acquiring HPV due to risky sexual behaviors and a greater likelihood of exposure to social networks with high prevalence of sexually transmitted infections. International studies suggest these populations may have a different HPV profile. In one of the largest studies of female sex workers, cervical lesions were commonly negative for HPV 16/18, suggesting a role for other high risk HPV (hr-HPV) types or multiple co-infections. Yet there is little known about the HPV profile of street sex workers in the United States. Building on a non-traditional partnership with law enforcement and over 36 community organizations (the Dallas Prostitute Diversion Initiative, Texas), we are providing cancer prevention screening services with HPV co-testing targeting those women diverted to substance abuse treatment centers. We report here on the prevalence of HPV serotypes across cervical and anal sites and across age groups that could inform future HPV vaccination efforts in this vulnerable population.

Methods: We partnered with AIDS Arms Clinic to create a point of access for cancer screenings among women in substance abuse treatment at Nexus Recovery, the largest female-only substance abuse recovery center in North Texas. Screenings provided include cervical and anal PAP screens with HPV co-testing (16, 18, or other hr-HPV). Other high risk types included 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, or 68 and were reported in aggregate. Also included were screenings for breast, hepatitis, and HIV/sexually transmitted infections. A follow-up clinic visit was provided 7 days from the initial screen as a second opportunity to educate, explain screen findings, and navigate positives to diagnostic care. This prevention services project is ongoing through August 2016 with the goal to screen 1220 women.

Results: A total of 538 women were screened for cervical and anal HPV. The average age was 33 years, 33% were non-white, and over 80% were smokers without health insurance. One-quarter reported 50+ lifetime sex partners. Twenty-nine percent were cervical hr-HPV positive, with 87% classified as other hr-HPV serotype and 13% as HPV 16/18+. Similarly, 32% of women were positive for anal hr-HPV, with the majority being other hr-HPV (88.4%). Unexpected was the bimodal age distribution of HPV prevalence, peaking at 22 years and 48 years.

Conclusion: The HPV serotypes observed in this study provide baseline HPV prevalence rates for monitoring future HPV vaccination efforts in this and similar underserved populations. This is significant since one of the fastest growing segments of the criminal population are women offenders serving time on probation for low level offenses related to drug activity and prostitution. HPV vaccination programs in this target population may need to be broadened to include mid-adult women and other serotypes in addition to HPV 16/18.

Citation Format: Martha J. Felini, Oluwatosin Igenoza, Saritha Bangara, Kelechi Ukpaka, Opeyemi Jegede, Shuchika Gupta, Gene W. Voskuhl, Timothy Kremer, Ralph Anderson, Raquel Qualls-Hampton. Cervical and anal HPV serotype-specific prevalence among high-risk indigent women in substance abuse recovery. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B69.