Prevalence, genotype distribution and associated factors of high-risk human papillomavirus among pregnant women in Eastern Ethiopia: a cross-sectional analysis nested within a population-based cohort study

High-risk human papillomavirus (HR-HPV) infection is the main cause of cervical precancer and cancer. Although Ethiopia introduced the quadrivalent Gardasil ® HPV vaccine (targeting HPV6, 11, 16, and 18), data on the distribution of HR-HPV genotype and the coverage provided by the vaccine remains limited. We assessed the prevalence, genotype distribution, theoretical vaccine coverage, and associated maternal factors for HR-HPV among apparently healthy pregnant women in eastern Ethiopia. This study was a cross-sectional analysis nested within the EthiOMICS cohort, a population based longitudinal study of pregnant women (12–22 weeks of gestation) recruited from the Hararghe Health and Demographic Surveillance System Site. A total of 217 vaginal swabs were collected, genomic DNA was extracted, and HR-HPV detection was performed using the Seegene HR HPV Allplex™ assay targeting 14 high-risk genotypes. Data were analyzed using SPSS version 28. Among the 217 pregnant women, HR-HPV prevalence was 12.9% (95% CI: 8.8–18.1). HPV16 and HPV66 were the most common genotypes (21.4% each), followed by HPV31, HPV58, and HPV51 (17.9% each); 35.7% of HPV-positive women harbored multiple HR-HPV genotypes. Participant-level theoretical genotype-based coverage among HR-HPV-positive women was 25.0% for the quadrivalent vaccine and 71.4% for the 9-valent vaccine. Detection of Ureaplasma parvum and Mycoplasma hominis was associated with HR-HPV in the adjusted exploratory analysis. More than one in eight pregnant women harbored HR-HPV, and more than one-third of these women had multiple high-risk genotypes. Theoretical participant-level genotype-based coverage of the quadrivalent vaccine currently used in Ethiopia was 25.0% among HR-HPV-positive women. These findings highlight the diversity of circulating HR-HPV genotypes among pregnant women in eastern Ethiopia and underscore the importance of continued molecular surveillance.