HPV Epidemiology and Response to Screening (HEARTS)

描述（由研究者提供）：HPV疫苗的开发和临床研究主要集中在普通人群中的女性，而对贫困妇女中的HPV知之甚少，其中许多人在一生中都会反复经历性传播感染的风险。在这一人群中，反复暴露于HPV以及合并感染（如HIV、HCV、淋病和衣原体）对HPV感染和HPV相关疾病的自然史的影响尚不清楚。此外，HPV亚型在这一人群中的流行程度尚不清楚，这就妨碍了对潜在疫苗有效性的估计。更好地了解美国贫困妇女的HPV可能会对改善卫生保健服务，特别是HPV疫苗的摄取和有效性产生影响。我们建议进行一项探索性研究，以评估宫颈HPV和宫颈HPV疾病（宫颈上皮内瘤变）的患病率和变异性；与合并感染（如艾滋病毒、丙型肝炎病毒、淋病和衣原体）和药物使用（如烟草和快克可卡因）的关联；以及在无家可归和无住房妇女中进行更大规模随机研究的可行性。将从无家可归者收容所、免费食品计划和低收入单人房入住酒店招募个人。通过这种方式，研究参与者将不局限于访问特定机构的个人，从而促进基于社区的样本的可靠估计。

DESCRIPTION (provided by investigator): HPV vaccine development and clinical research have focused on women from the general population and little is known about HPV among indigent women, many of whom experience repeated risk for sexually transmitted infections that continues through the span of their lives. The impact of repeated exposure to HPV, as well as the impact of co-infections like HIV, HCV, gonorrhea, and Chlamydia, on the natural history of HPV infection and HPV-associated disease, is unclear in this population. Moreover, the prevalence of HPV subtypes in this population is unknown, which precludes estimates of potential vaccine effectiveness. A better understanding of HPV among indigent US women could have implications for improvement in health care delivery, particularly regarding HPV vaccine uptake and effectiveness. We propose an exploratory study to assess the prevalence and variability of cervical HPV and cervical HPV disease (cervical intraepithelial neoplasia); associations with co-infections (i.e., HIV, HCV, gonorrhea and Chlamydia) and drug use (e.g., tobacco and crack cocaine); and the feasibility of a larger randomized study among homeless and marginally housed women. Individuals will be recruited from homeless shelters, free food programs and low-income single room occupancy hotels. In this way, study participants will not be limited to individuals who visit specific institutions, thus facilitating reliable estimates from a community-based sample. PUBLIC HEALTH RELEVANCE: To the best of our knowledge, this is the first study regarding HPV and HPV disease among homeless and marginally housed women. Ascertaining prevalence and risk factors specific to this population will facilitate a better understanding of HPV among indigent US women, which could have implications for improvement in health care delivery, particularly regarding HPV vaccine uptake and effectiveness. Given that poor and marginally housed women use health services infrequently, the potential benefits of a prophylactic vaccine are of the utmost importance.