Introduction: Certain microbial community states of the genital lower tract often characterized by low Lactobacillus species have been associated with high pH, bacterial vaginosis, immune cell infiltration, and an increased risk of human papillomavirus (HPV) infection and gynecological malignancies. Yet, there is a paucity of data on the cervicovaginal microbiota profile in Mozambican women.

Aim: We analyzed the cervicovaginal microbiota of 353 cervicovaginal samples from a cohort of reproductive-age Mozambican women, who participated in the DREAM Sant’Egidio HPV-Cervical Cancer Screening Program, in Maputo, Mozambique.

Methods: This cross-sectional study was conducted between July 2021 and May 2022. High-risk HPV detection was performed using the Cobas® 4800 HPV DNA assay (Roche Molecular Systems, Pleasanton, California, USA), and microbiome analysis was performed with commercial kits for the detection of 10 typical cervicovaginal bacteria by PCR, with 16S ribosomal RNA gene amplicon pyrosequencing.

Results: We found three cervicovaginal microbiota CSTs: CST I (L. crispatus-dominated), CST IV-A (modest proportions of Lactobacillus species), and CST IV-B (higher proportions and diversity of non-Lactobacillus species). CSTs deferred between the clusters and according to HIV Status (P<0.05). More than half (62%) sampled had CST IV-B (HIV-positive, n= 144 vs HIV-negative, n= 75), compared to CST I (19.3%; HIV-positive, n= 33 vs HIV-negative, n= 35) and CST IV-A (18.7%; HIV-positive, n= 35 vs HIV-negative, n= 31).

Conclusions: This study sheds light on the cervicovaginal microbiota profile of reproductive-age Mozambican women in the context of high-risk HPV infection and cervical cancer screening. The findings highlight the potential role of cervicovaginal microbiota as a factor to be considered for the identification of women at risk for HPV-dependent cervical cancer, and the need for comprehensive microbiota studies in the country.

Keywords: Cervical cancer, Human papillomavirus, Microbial community state type.