Abstract
BACKGROUND: In 2017, Armenia introduced a national human papillomavirus (HPV) vaccination programme with a quadrivalent vaccine at age 14 years. Successful implementation of the programme was affected by social media campaigns aiming to discredit its efficacy and safety, the COVID-19 pandemic, and local armed conflicts. To support national public health stakeholders, we initiated a series of studies to provide local evidence on the burden of HPV infection. METHODS: Two cross-sectional HPV prevalence surveys among unvaccinated birth-cohorts of women were conducted: a urine-based survey (UBS) targeted women aged 17-21 years, and a cell-based survey (CBS) targeted women aged 21-39 years. In addition, we collected a series of invasive cervical cancer (CC) case laboratory samples to assess the attributable proportion of high-risk (HR) HPV types to estimate the impact of HPV vaccination in Armenia. FINDINGS: In the UBS and the CBS, 2485 and 3017 women were included, respectively. In the UBS, 110 (4.5 %) women were positive for any HPV type, 72 (2.9 %) of which were HR HPV and 29 (1.2 %) were HPV16/18. In the CBS, 553 (18 %) were positive for any HPV type, 326 (11 %) of which were HR HPV, and 99 (3.3 %) were HPV16/18. In the CC series, HPV16/18 accounted for 71 % of all HR HPV infections, HPV 31, 33, 45, 52, and 58 accounted for an extra 18 %. The remaining HR types accounted for 11 % of all CC infected by HR HPV. The corresponding predicted cumulative 10-year CC incidence among 20-24, 25-34, and 35-44-year age group, was 0.3 %, 1.3 %, and 3.8 %, respectively. INTERPRETATION: Our findings provide a picture of the HPV infection and future cervical cancer burden among unvaccinated young and adult women in urban areas of Armenia and can inform context-specific vaccination and screening policies.