Taking it to their doorstep: outreach well-woman clinics in brothels for cervical cancer screening of female sex workers in North-Western Nigeria

Female sex workers (FSWs) are at increased risk for HPV, precancerous lesions, and cervical cancer (CaCx), yet they tend to be screened at lower rates than other women. However, data on the prevalence of high-risk HPV (hrHPV) and cervical cytological abnormalities among FSWs are limited in Nigeria, with no data available from North-western Nigeria. This study aimed to assess the prevalence of HPV 16 and 18 infections and cervical cytological abnormalities among FSWs in Sokoto State, and to identify factors associated with HPV 16/18 infection among this vulnerable group. This cross-sectional study involved 165 FSWs who were recruited during outreach well-woman clinics conducted in brothels. After obtaining informed consent, data were obtained through a structured questionnaire administered by interviewers, followed by cervical smear collection. Liquid-based cytology (LBC) and real-time PCR testing for HPV DNA were performed on the samples. Binary logistic regression was applied to explore potential predictors of HPV 16/18 infection. The majority of respondents (119; 72.9%) consented to CaCx screening. Over half (65; 54.6%) tested positive for HPV 16/18. Single HPV 16 infection (34; 28.6%) was twice as common as single HPV 18 infection (17; 14.3%), while 14 respondents (11.8%) had co-infection. Cervical cytological abnormalities were detected in 10 participants (8.4%), predominantly low-grade squamous intraepithelial lesions (LSIL), which comprised 90% of the abnormalities. HPV 16/18 prevalence was highest in the 30–39 age group (23; 42.6%), while abnormal cytology occurred exclusively in the 21–39 age groups at similar rates. In bivariate analysis, age at coitarche, age at first marriage, and years engaged in sex work were significantly associated with HPV infection. However, only years engaged in sex work remained a significant predictor of HPV 16/18 infection in regression analysis (aOR = 5.13; 95% CI: 1.53–17.22; p = 0.008). HPV 16/18 infection were highly prevalent among respondents, despite a relatively low prevalence of cervical cytological abnormalities. These findings highlight the potential benefit of the bivalent HPV vaccine in Sokoto State. Regular CaCx screening is strongly recommended for FSWs, even after they disengage from sex work. Further research with a larger sample size and comprehensive testing for all high-risk HPV genotypes is recommended.