HPV Epidemiology and Response to Screening (HEARTS)

描述(由研究人员提供)：HPV疫苗的开发和临床研究主要集中在普通人群中的妇女，对贫困妇女中的HPV知之甚少，她们中的许多人在一生中反复经历性传播感染的风险。在这一人群中，反复接触HPV以及艾滋病毒、丙型肝炎病毒、淋病和衣原体等混合感染对HPV感染和HPV相关疾病的自然病史的影响尚不清楚。此外，该人群中HPV亚型的流行率尚不清楚，这排除了对潜在疫苗有效性的估计。在贫困的美国妇女中更好地了解HPV可能会对改善卫生保健提供产生影响，特别是在HPV疫苗的接种率和有效性方面。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；与混合感染(即艾滋病毒、丙型肝炎、淋病和衣原体)和药物使用(如烟草和强效可卡因)的相关性；以及在无家可归和边缘居住的妇女中进行更大规模随机研究的可行性。个人将从无家可归者收容所、免费食品计划和低收入单间入住酒店招募。这样，研究参与者将不会局限于访问特定机构的个人，从而便于从基于社区的样本进行可靠的估计。 公共卫生相关性：据我们所知，这是关于无家可归和居住在边缘地区的妇女中的HPV和HPV疾病的第一项研究。确定这一人群特有的流行率和风险因素将有助于更好地了解美国贫困妇女中的HPV，这可能对改善卫生保健提供产生影响，特别是在HPV疫苗接种率和有效性方面。鉴于贫穷和居住条件较差的妇女很少使用卫生服务，预防性疫苗的潜在好处至关重要。

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.