High-risk HPV detection via GeneXpert in self-collected anal swabs among MSM living with HIV: Insights from a cross-sectional study

Background Men who have sex with men living with HIV (MSMLWHIV) have a high risk of persistent high-risk HPV infection, and rapid tools like Xpert HPV can help expand screening in low-resource settings. Objectives This study aimed to assess the feasibility of using self-collected anal swabs for detecting high-risk human papillomavirus (HR-HPV) infections in MSMLWHIV, using the Xpert® HPV assay. Additionally, we investigated factors associated with HR-HPV positivity. Design This was a single-center cross-sectional study conducted from 22 nd May 2024 to 31 st July 2024 among MSMLWHIV in Bamako. Methods Participants were recruited from the Soutoura NGO in Bamako, Mali. To be eligible, individuals had to be HIV-1 positive, on antiretroviral therapy, 18 years or older, and self-identified as MSM. The prevalence of HR-HPV was reported by sociodemographic characteristics and sexual behaviors. We used a penalized logistic regression model using Firth’s method to identify sociodemographic and behavioral factors associated with HR-HPV positivity. Results A total of 245 MSMLWHIV were initially tested. Of these, 170 yielded successful results and were subsequently included in the study analysis. The participants had a median age of 26 years (IQR 24-29) with the median age of first anal intercourse at 16 years (IQR 16-18). Among the participants, 29% (49/170) identified as bisexual, 42% (72/170) reported never using condoms, 16% (27/170) participated in group intercourse, and 42% (71/170) had at least two different sexual partners in the past six months. Among those successfully tested, 65% (110/170) were positive for HR-HPV, with HPV16 detected in 12% (21/170) of participants. No or primary education and consistent condom use were associated with lower odds of HR-HPV positivity, while the unexpected association observed with smoking should be interpreted with caution. Conclusion The high HR-HPV prevalence among MSMLWHIV calls for targeted screening and prevention. Although Xpert HPV shows promise, the 31% failure rate with self-collected samples underscores the need for improvements in sample collection procedures and technical performance.