Molecular epidemiology of cervical high-risk human papillomavirus infection in Ethiopia (2000–2026): a systematic review and meta-analysis

Cervical cancer is a major cause of cancer-related morbidity and mortality among women in Ethiopia and is largely attributable to persistent infection with high-risk human papillomavirus (HR-HPV). Women living with HIV have an increased risk of persistent HR-HPV infection. This systematic review and meta-analysis aimed to estimate the prevalence of cervical HR-HPV infection among Ethiopian women and describe regional and genotype-specific distributions. PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and African Journals Online were searched from January 2000 to February 2026. Eligible studies were observational studies that used validated molecular HPV-detection methods in Ethiopian women. Pooled prevalence estimates with 95% confidence intervals (CIs) were calculated using the DerSimonian-Laird random-effects model following Freeman-Tukey double-arcsine transformation. Heterogeneity was assessed with I² and Cochran’s Q and pre-specified subgroup analyses examined geographic region, study approach, and study setting. Twenty-seven studies ( n = 14,225 women) from six Ethiopian regions met inclusion criteria. The overall pooled HR-HPV prevalence was 33.6% (95% CI: 28.4, 38.9), with substantial heterogeneity (I² = 99.9%, p < 0.001). Prevalence varied significantly by region ( p < 0.001): Amhara 46.5% (95% CI: 20.2, 70.6), Addis Ababa 37.0% (95% CI: 22.9, 51.1), Oromia 28.2% (95% CI: 24.5, 32.0), SNNP 15.8% (95% CI: 12.7, 18.9), and Somali/Harar 13.1% (95% CI: 10.9, 15.3); the SNNP, Somali/Harar, and multiple-regions estimates are each based on a single primary study and should be regarded as preliminary. Among HR-HPV-positive women, HPV-16 was the most prevalent genotype 32.0%, (95% CI: 23.9, 40.1), followed by HPV-31 (8.9%), HPV-35 (7.6%), HPV-45 (6.4%), and HPV-18 (6.0%). The nonavalent vaccine was estimated to cover 68.3% of detected genotypes, compared with 37.9% for the bivalent/quadrivalent vaccines. The findings indicate a substantial burden of cervical HR-HPV infection among Ethiopian women, although the very high between-study heterogeneity limits interpretation of the pooled estimate as a precise national prevalence. HPV-16 was the most frequently detected genotype, while several non-16/18 high-risk types were also commonly identified. These findings support strengthening and expanding HPV vaccination and cervical cancer screening services and establishing national HPV genotype surveillance to monitor genotype distribution over time. Future research should prioritize population-based studies in underrepresented regions and longitudinal studies to establish post-vaccination baseline trends and evaluate changes in HR-HPV genotype distribution.