P1-S2.70 The detection and management of pelvic inflammatory disease in aboriginal women in Central Australia: challenges of a remote high prevalence setting

Abstract

Background: Information on human papillomavirus (HPV) prevalence among Aboriginal populations (First Nations, Metis, Inuit) in Canada remains scarce but is needed for informed public health programming. This need is reinforced by the rapidly changing rates of cervical cancer screening in these populations and the introduction of prophylactic vaccines. Method In 2008, 52 clinics across the province of Manitoba, Canada participated in a Pap Week initiative during which left over tissues from conventional Pap tests were used for HPV typing using the Luminex method (developed by the National Microbiology Laboratory). A risk-behaviour survey was also administered to consenting women. Chi-square was used to compare frequencies and logistic regression was used to model the data. The most significant factors were included in the multivariate logistic model. Results: Of 592 women recruited, 113 self-reported being Meti or First Nations (M/FN); 70 did not report their ethnic background and were excluded from the analysis. M/FN participants were younger than the non-M/FN participants (mean age: 39 vs 45, p<0.0001). HPV infection prevalence was 2.3 times higher in M/FN than in other participants (32.7% vs 14.2%, p<0.0001). This increase was mainly due to the higher prevalence of HPV 32, 35, 51, 58, and 62. The prevalence of HPV 16 and 18 in the M/FN population was comparable to that of the non-M/FN (p=0.64), although HPV 18 slightly higher in M/FN (5.6% vs 3.8%). Compared to their non- Aboriginal counterparts, M/FN women participating in the study were more often smokers (p<0.0001), had a higher number of sexual partners in the last year (p=0.0004), and were more often in an unstable relationship (p=0.03). The strongest predictors for HPV infection in the study population were the number of sexual partners over the last year (OR 5.71; 95% CI 3.08 to 10.58) and having reported a M/FN identity (OR 2.17; 95% CI 1.28 to 3.69). Conclusion Certain types of HPV may be more prevalent in M/FN than in the non-Aboriginal population. Although it is clear that the HPV vaccine has the potential to lower the prevalence of HPV 6, 11, 16, and 18 infections and related diseases in the M/FN population living in Manitoba, its impact could be mitigated by the relatively high prevalence of other HPV types.