Abstract
Background: Female genital schistosomiasis (FGS) is a neglected and disabling gynaecological disorder that is difficult to diagnose and is part of the wider spectrum of urogenital disease caused by the waterborne parasite Schistosoma haematobium. Over 90% of human schistosomiasis cases are found in sub-Saharan Africa with 3.8 million people infected with schistosomes in Zambia. Reported FGS prevalence ranges from 33-75% of those with urinary schistosomiasis in endemic areas, suggesting a potentially high FGS burden in Zambia alone. The Bilharzia and HIV (BILHIV) study evaluated home self-sampling genital collection methods for the diagnosis of FGS. Methods: Eligible participants included non-pregnant, sexually active women aged 18-31 who were previously recruited for the HPTN 071 (PopART) trial in Livingstone, Zambia. Household demographic and symptom questionnaires were administered by community workers. Participants were offered vaginal and cervical self-swabs and a urine cup. Cervicovaginal lavage (CVL) was performed in clinic by midwives. Information was collected from participants on the acceptability and feasibility of genital self-sampling. Results: From January-August 2018, 603 women were enrolled, and 87.3% (527/603) completed clinic follow up. A high proportion of participants indicated that self-collection of specimens was “easy” or “very easy” on a 5-point Likert scale. A high proportion of women would be willing to self-collect all three specimens again in future: vaginal swab 96.7% (583/603), cervical swab 96.5% (582/603), and urine 96.2% (580/603). Home-based self-sampling was preferred over provider-based sampling in the clinic due to greater privacy 58.5% (353/603), convenience 46.3% (279/603) and need for transportation 15.9% (96/603). Conclusions: Home based genital self-sampling for FGS diagnosis is highly acceptable. This scalable method may inform future efforts for community-based diagnosis of FGS.
Highlights
Human schistosomiasis is a waterborne parasitic disease caused by blood flukes of the genus Schistosoma[1,2]
Non-pregnant, sexually active women aged 18–31 who had previously been recruited for the HPTN 071 (PopART) population cohort were eligible for inclusion in Bilharzia and HIV (BILHIV)
Acceptability and feasibility Out of 603 women recruited, a high proportion indicated that self-collection of genital specimens was “easy” or “very easy” on a 5-point Likert scale for urine collection (96.2%; 580/603), vaginal swab (94.9%; 572/603), and cervical swab (86.6%; 522/603) (Figure 3; Table 2)
Summary
Human schistosomiasis is a waterborne parasitic disease caused by blood flukes of the genus Schistosoma[1,2]. It constitutes a significant public health problem causing the loss of 1,440 million years of full health worldwide, with approximately 659 million people at risk of acquiring infection[2,3]. Female genital schistosomiasis (FGS) is a neglected and disabling gynaecological disorder that is difficult to diagnose and is part of the wider spectrum of urogenital disease caused by the waterborne parasite Schistosoma haematobium. The Bilharzia and HIV (BILHIV) study evaluated home self-sampling genital collection methods for the diagnosis of FGS. A high proportion of women would be willing to self-collect all three specimens again in future: vaginal swab 96.7% (583/603), cervical swab 96.5% (582/603), and urine 96.2% (580/603). Conclusions: Home based genital self-sampling for FGS diagnosis is
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