Full Project 1: Using Community-Engaged Research to Assess the Association of the Cervicovaginal Microenvironment and HPV Persistence and Clearance in Native American Women

Northern Arizona University, Flagstaff AZ

Investigators

Linked publications & trials

Abstract

Approximately 11,000 new cases of cervical cancer were diagnosed in the US in 2018. While the cervical cancer mortality rate declined, approximately 4,000 women still die from this disease every year. Hispanic and American Indian Alaska Native (AIAN) women have the highest rates of cervical cancer in Arizona, with respectively, 7.8 and 7.1 cases per 100,000 women. While HPV is the known etiologic agent of cervical cancer, few studies were conducted to estimate HPV prevalence within AIAN communities. Among those studies, it was reported that 22.2% of AIAN women from the Hopi reservation in northeastern Arizona tested positive for HPV infection. The deficiencies of both cervical screening and higher HPV prevalence are likely contributors to higher incidence of cervical cancer AIAN women. Yet, evidence suggests an association of HPV infection, persistence, and disease progression with vaginal microbiota (VMB) features. Little is known about the patterns of HPV infection and VMB composition in AIAN communities, or how these factors relate to increased cervical cancer risk. In fact, most prior studies do not include AIAN women. We hypothesize that there are dual factors (perceptions and biological factors within the cervicovaginal microenvironment) that contribute to HPV persistence and, ultimately, cervical cancer rates in AIAN women. For this 3-year full project, we will continue working with the MedStar Health Research Institute in Phoenix, AZ. Thus, the aims of this project are to (1) assess the knowledge and perspectives of cultural practices, HPV-associated cancers, and STI knowledge among urban AIAN women, and (2) define changes in the vaginal microbiota and immunometabolic milieu in a longitudinal study of urban AIAN women to better understand the relationship between these factors and HPV infection, persistence, and clearance. From these aims, we will (1) determine the prevalence of modifiable risk factors and behaviors for HPV infection and HPV-related cancers among AIAN women; (2) assess knowledge and perceptions regarding HPV-related cancers among AIAN women; (3) determine the individual HPV status, levels of vaginal inflammatory mediators, metabolites and the VMB abundance in AIAN women across a longitudinal study; (4) evaluate the risk factors associated with prevalent HPV types and the VMB; and (5) conduct integrated multi-omics analysis in AIAN women focused on features of the local microenvironment associated with HPV status. Therefore, this 3-year full project will include community-informed community-based biomedical research and apply two-eyed seeing as a guiding perspective with the long-term goal of reducing the incidence of HPV associated cancers in AIAN women.