ORIGINAL ARTICLE Oral HPV among people who use crack-cocaine: prevalence, genotypes, risk factors, and key interventions in a remote Northern Brazilian region Mayara Sabrina A. Rodrigues 1,2 & Raquel Silva Nascimento 1,3 & Ricardo Roberto S. Fonseca 4,5 & Gláucia C. Silva-Oliveira 1 & Luiz Fernando A. Machado 4,5 & Emil Kupek 6 & Benedikt Fischer 7,8,9 & Aldemir B. Oliveira-Filho 1,3 Received: 13 August 2020 /Accepted: 17 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Objectives This study estimated the prevalence, genotype distribution, and the factors associated with oral human papillomavirus (HPV) in people who use crack-cocaine (PWUCC) in a remote Brazilian region. Materials and methods This cross-sectional study used community-based snowball sampling methods for participant recruit- ment. Socio-demographic, economic, drug use, and health-related information was collected from 278 PWUCC in the cities of Bragança and Capanema in northern Brazil. HPV diagnosis and genotyping were performed by a real-time polymerase chain reaction. Logistic regression identified the factors independently associated with oral HPV. Results In total, 111 (39.9%) PWUCC had HPV DNA. Several genotypes were identified, some of them with high oncogenic potential. Crack-cocaine use ≥40 months, unprotected sex, more than 10 sexual partners in the last 12 months, oral sex, exchange of sex for money or illicit drugs, oral mucosa lesions, not having access to public health services, and the absence of vaccination against HPV was all associated with HPV DNA. Conclusions This study identified important epidemiological characteristics of oral HPV infection among PWUCC—a highly marginalized risk population—underlining the high prevalence of oral HPV with oncogenic potential and the urgent need for control and prevention measures, especially vaccination against this virus. Clinical relevance It is necessary to understand the prevalence and risk factors of oral HPV in risk populations as people who use crack-cocaine. Keywords Oral HPV . Crack-cocaine . Oncogenic viruses . Epidemiology . Interventions . Brazil * Aldemir B. Oliveira-Filho olivfilho@ufpa.br 1 Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Rua Leandro Ribeiro, s/n. Aldeia, Bragança, PA, Brazil 2 Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antonio Maria Zaccaria, Bragança, PA, Brazil 3 Programa de Pós-Graduação em Biologia Ambiental, Universidade Federal do Pará, Bragança, PA, Brazil 4 Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários, Universidade Federal do Pará, Belém, PA, Brazil 5 Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil 6 Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil 7 Faculty of Medical and Health Sciences, University of Auckland, Grafton, New Zealand 8 Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada 9 Departamento de Psiquiatria, Federal Universidade de São Paulo, São Paulo, SP, Brazil Clinical Oral Investigations https://doi.org/10.1007/s00784-020-03698-3