Assessing the Incidence, Persistence and Clearance of Oral HPV Detection Among Metropolitan and Non-Metropolitan Indigenous Australian Adults

Background: Human papillomavirus (HPV) infects skin and mucous membranes, and high-risk types are associated with oropharyngeal and other cancers. Longitudinal evidence on oral HPV among Aboriginal and Torres Strait Islander peoples remains limited, particularly across geographic settings. Methods: A longitudinal cohort study was conducted among 1011 Indigenous Australian adults in South Australia recruited through Aboriginal Community Controlled Health Organisations. Participants provided saliva samples and completed questionnaires at baseline (2018–2019) and at 12- and 24-month follow-up. Oral HPV was detected using PCR-based assays. Incidence, persistence, and clearance were estimated, and multivariable regression examined associations with behavioural, sexual health, and socioeconomic factors. Results: Oral HPV dynamics differed between metropolitan and non-metropolitan participants. Approximately one-quarter developed an incident infection, with geographic variation in persistence and clearance. Smoking, sexual behaviours, and socioeconomic factors were associated with HPV outcomes. Older age was associated with persistence among non-metropolitan participants, while smoking was associated with higher incidence among metropolitan participants. Conclusions: Oral HPV detection dynamics varied by geographic setting. Culturally appropriate, targeted public health strategies addressing behavioural and social determinants are needed to reduce HPV-related disease burden.