Sampling constraints, sparse-cell estimates, and cross-sectional inference: considerations on hr-HPV prevalence and associated factors among HIV-positive women in Mekelle, Ethiopia

Shfare et al. report a high-risk human papillomavirus (hr-HPV) prevalence of 39.7% among HIV-positive women attending public health facilities in Mekelle, Ethiopia, and identify several clinical and behavioural predictors using multivariable logistic regression. The study addresses an important evidence gap in a high-burden setting and employs rigorous molecular detection methods. Nevertheless, three methodological considerations affect the interpretation of the findings. First, facility-based recruitment from selected antiretroviral therapy (ART) clinics may limit the generalizability of the reported prevalence estimate and observed associations to the broader population of women living with HIV. Second, several adjusted odds ratios are accompanied by wide confidence intervals, indicating limited precision and warranting cautious interpretation. Finally, the cross-sectional design precludes causal inference regarding the association between oral contraceptive use and hr-HPV infection because residual confounding and reverse causation cannot be excluded. Collectively, these issues suggest that the findings should be interpreted cautiously and highlight the need for prospective population-based studies to validate the reported risk factors before they inform screening or prevention strategies.