Megan Fitzpatrick, MD

meganfitzpatrickGHES US Fellow 2016-2017

E-mail: megan6@stanford.edu
Fellowship Site: University of Zimbabwe
U.S. Institution: Stanford University

Project Title: Prevalence and subtype distribution of high-risk Human Papilloma virus in HIV-positive and HIV-negative women in rural Zimbabwe

Cervical cancer is the leading cause of cancer and cancer-related death among women in low income countries. Zimbabwe ranks fifth in age-standardized cervical cancer incidence (56.4 per 100,000). Liquid-based cytology (Pap smear) requires infrastructure, training, and follow-up care typically not available in low and middle-income countries (LMIC). Visual inspection with acetic acid (VIA) as a surrogate for identification and treatment of high-risk lesions is a subjective test that may not always identify or adequately treat cervical lesions. Therefore, screening strategies that detect infection with high-risk Human Papilloma virus (HR-HPV) are an important alternative approach for the detection of cervical intraepithelial neoplasia (CIN) and cancer.

While studies in Zimbabwe have examined the subtypes of HR-HPV among previously diagnosed cervical cancers, the prevalence and distribution of HR-HPV are unknown in the general population. Recently, the Zimbabwe Ministry of Health completed demonstration projects HPV vaccination with the bivalent vaccine (HPV 16 &18) for girls 9-13 years old in Marodera and Beit Bridge Districts. Subtype distribution in the general population is necessary to assess the feasibility, costs, and benefits of continued screening efforts and new multivalent vaccine strategies. A better understanding of the epidemiology and subtype distribution is needed to optimize the continued screening and vaccination efforts in Zimbabwe, especially among HIV-positive women. The research project proposed will build capacity in molecular diagnostic methods to describe the prevalence and distribution of HR-HPV subtypes in Zimbabwe as a comorbid opportunistic infection/cancer.

Research project activities:
Using self-collected cervicovaginal swabs, we will collect DNA and mRNA to analyze novel molecular diagnostics methods to describe the subtype distribution in rural areas of Zimbabwe. We have partnered with a rural Mission Hospital to collect samples at outreach clinic days including HIV HAART treatment clinics in the region.