{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T17:58:54Z","timestamp":1780941534095,"version":"3.54.1"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Montserrat is a UK Overseas Territory in the Caribbean without a universal human papillomavirus (HPV) vaccination programme for its population of 4,386. Montserrat operates limited colposcopy and cervical cancer screening services, therefore lacking evidence to determine the prevalence of high-risk HPV associated with cervical cancer. We aimed to determine the prevalence of high-risk HPV and factors associated with testing positive in women in Montserrat to inform preventive strategies. Using 2023 census data, we applied random spatial sampling to select 520 buildings and recruit 208 women based on an estimated high-risk HPV prevalence of 20%, with 5% precision at 5% significance level, anticipating a 40% response rate. Resident women aged 25\u201364 years were invited to participate and given the choice between self-collection or clinician-administered sampling. Samples were tested with the GeneXpert assay for 14 high-risk HPV genotypes. Sampling weights were applied to reflect the age distribution in the population. Known risk factors associated with high-risk HPV positivity were collected via questionnaire (including age group) and prevalence ratios calculated using binomial regression. Of 225 eligible women, 206 (92%) consented to participate with 187 women submitting a sample (83% of those eligible). 96% opted for self-sampling. All eligible age groups were represented in the study population. Overall high-risk HPV prevalence was 14.6% (95%CI:10.2-20.6); prevalence of HPV16 was 1.9% (95%CI:0.7-5.1) and HPV18\/45 was 1.6% (95%CI:0.5-5.0) respectively. Prevalence of a positive test increased with younger age and those aged 25\u201334 years had three\u2011fold greater prevalence compared to 55\u201364 years (PR\u2009=\u20093.16, 95%CI:0.93\u201310.7; p\u2009=\u20090.064). Our findings suggest that vaccine-preventable high-risk HPV is present in the female population in Montserrat, with a trend of increased prevalence in younger age groups consistent with findings from previous Caribbean Island studies. Universal or age-targeted screening and vaccination programmes should be considered. Self-sampling HPV testing was highly acceptable to women.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006561","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T17:22:58Z","timestamp":1780939378000},"page":"e0006561","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["High-risk human papillomavirus prevalence and factors associated with testing positive in women living in Montserrat"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2778-3362","authenticated-orcid":true,"given":"Caroline","family":"Harris","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffannie","family":"Skerritt-Flemming","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothea","family":"Hazel-Blake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penny","family":"Maloney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimona","family":"Daniel-Bourne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7764-554X","authenticated-orcid":true,"given":"Alicia","family":"Barrasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3518-8333","authenticated-orcid":true,"given":"Orwin","family":"Mosley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0045-9802","authenticated-orcid":true,"given":"Anna","family":"Tirion","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riinu","family":"Pae","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5179-5906","authenticated-orcid":true,"given":"Sharra","family":"Greenaway-Duberry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Manley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"pgph.0006561.ref001","unstructured":"Statistics Department Montserrat. Census 2023. 2024. https:\/\/statistics.gov.ms\/census-2023"},{"key":"pgph.0006561.ref002","unstructured":"WHO. Human papillomavirus and cancer. 2024. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/human-papilloma-virus-and-cancer"},{"key":"pgph.0006561.ref003","unstructured":"Cancer Research UK. Risks and causes of cervical cancer. 2023. https:\/\/www.cancerresearchuk.org\/about-cancer\/cervical-cancer\/risks-causes"},{"issue":"1","key":"pgph.0006561.ref004","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1038\/sj.bjc.6600688","article-title":"Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis","volume":"88","author":"GM Clifford","year":"2003","journal-title":"Br J Cancer"},{"key":"pgph.0006561.ref005","unstructured":"UKHSA. HPV Green Book Chapter 18a. 2023. https:\/\/assets.publishing.service.gov.uk\/media\/649032b6b32b9e000ca969a7\/HPV-green-book-chapter-18a-June-2023.pdf"},{"issue":"7","key":"pgph.0006561.ref006","article-title":"Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study","volume":"2","author":"M Jit","year":"2014","journal-title":"Lancet Glob Health"},{"key":"pgph.0006561.ref007","unstructured":"WHO. Cervical Cancer Elimination Initiative. https:\/\/www.who.int\/initiatives\/cervical-cancer-elimination-initiative"},{"key":"pgph.0006561.ref008","unstructured":"UKHSA. HPV vaccination guidance for healthcare practitioners. 2023. https:\/\/www.gov.uk\/government\/publications\/hpv-universal-vaccination-guidance-for-health-professionals\/hpv-vaccination-guidance-for-healthcare-practitioners"},{"key":"pgph.0006561.ref009","unstructured":"Electronic Medicines Compendeum. Gardasil 9 suspension for injection. 2024. https:\/\/www.medicines.org.uk\/emc\/product\/7330\/pil"},{"key":"pgph.0006561.ref010","unstructured":"National Cervical Cancer Coalition. What You Need to Know About HPV Testing with Self-Collected Samples. 2025. https:\/\/www.nccc-online.org\/what-you-need-to-know-about-the-hpv-self-collection-test\/"},{"issue":"7","key":"pgph.0006561.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0181905","article-title":"Accuracy of self-collected vaginal dry swabs using the Xpert human papillomavirus assay","volume":"12","author":"R Catarino","year":"2017","journal-title":"PLoS One"},{"issue":"9","key":"pgph.0006561.ref012","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.jmoldx.2023.06.004","article-title":"Comparison of the clinical accuracy of Xpert HPV assay on vaginal self-samples and cervical clinician-taken samples within the VALHUDES framework","volume":"25","author":"A Latsuzbaia","year":"2023","journal-title":"J Mol Diagn"},{"issue":"1","key":"pgph.0006561.ref013","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/LGT.0000000000000575","article-title":"Performance of Xpert HPV on self-collected vaginal samples for cervical cancer screening among women in South Africa","volume":"25","author":"R Saidu","year":"2021","journal-title":"J Low Genit Tract Dis"},{"key":"pgph.0006561.ref014","doi-asserted-by":"crossref","first-page":"102672","DOI":"10.1016\/j.eclinm.2024.102672","article-title":"Opportunistic offering of self-sampling to non-attenders within the English cervical screening programme: a pragmatic, multicentre, implementation feasibility trial with randomly allocated cluster intervention start dates (YouScreen)","volume":"73","author":"AWW Lim","year":"2024","journal-title":"EClinicalMedicine"},{"issue":"7","key":"pgph.0006561.ref015","article-title":"Human papillomavirus (HPV) prevalence and associated risk factors in women from Cura\u00e7ao","volume":"13","author":"DJ Hooi","year":"2018","journal-title":"PLoS One"},{"issue":"10","key":"pgph.0006561.ref016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0257915","article-title":"Genotype distribution of cervical HPV among Caribbean women in a population-based study in Martinique: The DEPIPAPUFR study","volume":"16","author":"F Najioullah","year":"2021","journal-title":"PLoS One"},{"key":"pgph.0006561.ref017","article-title":"Prevalence of high-risk human papillomavirus among women in two English-speaking Caribbean countries","volume":"41","author":"G Andall-Brereton","year":"2017","journal-title":"Rev Panam Salud Publica"},{"key":"pgph.0006561.ref018","unstructured":"EPITOOLS. Sample size to estimate a proportion or apparent prevalence with specified precision. 2026. https:\/\/epitools.ausvet.com.au\/oneproportion"},{"key":"pgph.0006561.ref019","unstructured":"Statistics Department Montserrat. Environmental Statistics Compendium. 2020. https:\/\/statistics.gov.ms\/wp-content\/uploads\/2020\/10\/2020-Environmental-Compendium-2015-2019-Series-1.pdf"},{"key":"pgph.0006561.ref020","unstructured":"HPV World. Xpert HPV: Basis and key results in best trials. https:\/\/www.hpvworld.com\/articles\/xpert-hpv-basis-and-key-results-in-best-trials\/"},{"key":"pgph.0006561.ref021","unstructured":"Statistics Department Montserrat. 2023 Census Montserrat at a Glance. 2024. https:\/\/statistics.gov.ms\/wp-content\/uploads\/2025\/02\/Montserrat-At-A-Glance-2023.pdf"},{"issue":"8","key":"pgph.0006561.ref022","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1080\/21645515.2019.1697596","article-title":"Adolescent HPV vaccination: empowerment, equity and ethics","volume":"16","author":"N Sundaram","year":"2020","journal-title":"Hum Vaccin Immunother"},{"key":"pgph.0006561.ref023","unstructured":"International Agency for Research on Cancer. IARC Caribbean Cancer Registry Hub. 2021. https:\/\/caribbeancrh.carpha.org\/The-Caribbean-Hub\/Overview"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006561","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T17:23:04Z","timestamp":1780939384000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006561"}},"subtitle":[],"editor":[{"given":"Julia","family":"Robinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":23,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0006561","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]}}}