Vaccine-preventable HPV burden and cervical abnormalities in women during 2022–2024 Octobre Rose campaigns in Libreville

Cervical cancer is a leading cause of mortality in sub-Saharan Africa, largely driven by persistent carcinogenic human papillomavirus (HPV) infection. We conducted a 3-year cross-sectional study of 1,524 women participating in the national "Octobre Rose" campaigns in Libreville, Gabon. Cervical samples were assessed by visual inspection with acetic acid/Lugol iodine (VIA/VILI) and HPV genotyping using BioPerfectus Multiplex Real-Time PCR assay. Overall HPV prevalence was 21.0%, including 18.5% carcinogenic types and 11.0% covered by the nonavalent vaccine. HPV-35 was dominant, while Gardasil-9-targeted genotypes accounted for 63% of carcinogenic infections and the largest attributable fraction of VIA/VILI-detected abnormalities, particularly HPV-16 and HPV-45. HIV and high lifetime sexual exposure were independent predictors of carcinogenic HPV. These findings reveal a substantial burden of vaccine-preventable HPV in Gabon and underscore the high potential impact of Gardasil-9 implementation, while reinforcing the need for continued HPV-based screening to mitigate residual risk of non-vaccine types such as HPV-35.