Knowledge, Sexual Behaviors on Human Papillomavirus Infections and Associated Factors: Survey Among Female Adolescents and Adults in the Republic of Congo

Abstract

<i>Background</i>. Human papillomavirus (HPV) infection is sexually transmitted and responsible for anogenital warts and malignancies but its early diagnosis is hampered by the people’s lack of knowledge about the disease and prevention methods, especially in resource-limited countries. <i>Objective</i>. The study was designed to determine knowledge; attitudes and practices toward HPV infection in an urban women community, and evaluate the factors that are associated with HPV-related disease’s lack of knowledge. <i>Method</i>. Between February 2021 and August 2022, a cross sectional and prospective study was conducted in Pointe-Noire (PNR) and Brazzaville (BZV) region within the Republic of Congo. Anonymous questionnaire was used to explore demographics, knowledge, attitudes, and behaviors. Data analysis were performed using StataSE11 software (version 11 SE). <i>Results</i>. Overall 250 (96.2%) of 260 people surveyed agreed to participate and of these, 70.4% were recruited in Brazzaville and, the mean age was 20.9 (min-max: 15-35) years. A low proportion (21.6%) of women reported knowing what HPV is and of these, only 40.7% had adequate knowledge of HPV. 17.2% reported a knowledge of cervical cancer, 12.0% an adequate preventive measures and all of them were adults. The mean age of first sexual intercourse was 16.8 (IQ_25-75%: 16-18) years and statistically earlier in the adolescents (p=0.0001). The mean number of sexual partners was 2.6 (IQ_25-75%: 1-3). 56.8% of participants use condoms regularly and 10.4% occasionally and, less than one-third used oral contraception. Only 3 participants received HPV vaccine. HPV infection were found in 38.0% of participants, and significantly lower among adults than adolescents (10% <i>vs</i> 45.7%; OR=5.43, 95%CI: 1.97-14.97, p=0.001) and, than young adults (42.9%; OR=1.04, 95%CI: 3.24-33.06, p<0.0001). Participants with more than two sexual partners are twice for acquiring HPV infection (aOR=2.36, 95%CI: 1.33-4.21, p=0.003). Study area (aOR = 0.17, <i>p</i> = 0.0001), age > 18 years (aOR = 2.54, <i>p</i> = 0.03) and age at first intercourse (17 – 21 years) (aOR = 0.40, <i>p</i> = 0.04) were determinants of HPV knowledge. Study area (aOR = 0.03, <i>p</i> = 0.0001), age > 18 years (aOR = 6.18, <i>p</i> = 0.009), concubinage (aOR = 0.14, <i>p</i> = 0.001) and 3-4 sexual partners (aOR = 5.18, <i>p</i> = 0.004) were determinants of cervical cancer knowledge. <i>Conclusion</i>. These results highlight the important of developing and implementing appropriate outreach strategies to improve patient awareness and knowledge of HPV-related diseases and to promote HPV vaccination uptake targeting adolescents and young adults in the Republic of Congo.