Integrating female sexual and reproductive health screening in Zambia: one-stop self-sampling for schistosomiasis and other genital infections.

赞比亚女性性健康和生殖健康筛查一体化：针对血吸虫病和其他生殖器感染的一站式自我采样。

• 批准号: MR/T041900/1
• 负责人: Amaya Bustinduy
• 金额: $ 165.7万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT041900%2F1
• 关键词: Integrating; female; sexual; reproductive; health

The 'BILHIV in YourSELF' (pronounced; believe in YourSelf) study, is a novel one-stop approach for improving young women's sexual and reproductive health through community-based infection screening in Zambia, a country known to have high prevalence of HIV and cervical cancer. This novel strategy aims to integrate, in a single home visit and for the first time, self-sampling (genital and oral swabs) for the detection of multiple infections with serious consequences for female's sexual and reproductive health. The BILHIV in YourSELF study mainly focuses on the detection of female genital schistosomiasis (FGS), a chronic and disabling parasitic gynaecological disease that gets often confused with sexually transmitted diseases (STIs) due to their similarities in clinical presentations such as infertility, ectopic pregnancies, vaginal discharge and pain with coitus. An estimated 40 million women suffer from FGS in sub-Saharan Africa, and most of them are unaware of harbouring the disease. This is partly because detection of FGS is challenging, as it relies on expensive equipment and expertise that are seldom available in sub-Saharan Africa, where the disease is common. Small studies have documented an increased risk of acquiring HIV and cervical cancer in women with FGS, underlying the importance of approaching diagnosis of all genital infections in a comprehensive and holistic manner closer to the user. Genital self-sampling has been successfully implemented for the detection of different genital infections, including the work pioneered by the lead applicant in Zambia, validating genital self-swabs for the diagnosis of FGS. Results revealed acceptable sensitivity of genital swabs for the DNA detection of the parasite from women's genital tract, potentially offering, for the first time, a scalable diagnostic approach for a parasitic disease that has been unacceptably neglected. Also, self-sampling strategies have been used and validated for the detection of human papillomavirus (HPV), the causal agent for cervical cancer, allowing for possible community-based screening. All of these infections lead to serious downstream consequences for the sexual and reproductive health of women in SSA. As a consequence, multi-pathogen self-sampling and testing constitutes an unmissable opportunity to offer potentially life-changing health services closer to the users. An integrated wider approach for genital infection detection can also be a cost-effective strategy. The BILHIV in YourSELF study has as a holistic approach to FGS detection in the community within the wider scope of female sexual and reproductive health surveillance and linkage to care in Zambia. It will aim to validate genital self-sampling strategies in a large cohort of women in Zambia and follow them up for three years. At follow up, we will measure clinical progression or resolution of infection and lesions in addition to adherence and response to treatment. A thorough cost-effectiveness analysis will be performed aiming to find economically feasible ways to scale-up community based programmes that will integrate detection and care of FGS, HIV, cervical cancer and other STIs for women of reproductive age in SSA.

“BILHIV in YourSelf”（发音：相信你自己）研究是一种新颖的一站式方法，通过在赞比亚进行社区感染筛查来改善年轻妇女的性健康和生殖健康，赞比亚是一个已知的艾滋病毒和宫颈癌高发国家。这一新战略的目的是在一次家访中首次纳入自我采样（生殖器和口腔拭子），以检测对女性性健康和生殖健康造成严重后果的多种感染。BILHIV in YourSELF研究主要关注女性生殖器血吸虫病（FGS）的检测，这是一种慢性和致残性寄生虫妇科疾病，由于其临床表现相似，如不孕症，宫外孕，阴道分泌物和性交疼痛，经常与性传播疾病（STI）混淆。据估计，撒哈拉以南非洲有4 000万妇女患有FGS，其中大多数人不知道自己患有这种疾病。这部分是因为FGS的检测具有挑战性，因为它依赖于昂贵的设备和专业知识，而这些设备和专业知识在该疾病常见的撒哈拉以南非洲地区很难获得。小型研究记录了FGS妇女获得艾滋病毒和宫颈癌的风险增加，强调了以全面和整体的方式接近使用者诊断所有生殖器感染的重要性。生殖器自我取样已成功用于检测不同的生殖器感染，包括赞比亚的主要申请人率先开展的工作，即验证生殖器自我拭子用于诊断生殖器疱疹。结果显示，生殖器拭子用于女性生殖道寄生虫DNA检测的灵敏度可接受，这可能首次为被不可接受地忽视的寄生虫病提供可扩展的诊断方法。此外，还采用了自我取样战略，并验证了这种战略，以检测宫颈癌的致病因子-人乳头瘤病毒，从而有可能进行社区筛查。所有这些感染都对撒南非洲妇女的性健康和生殖健康造成严重的下游后果。因此，多病原体自我采样和检测是一个不容错过的机会，可以在更靠近用户的地方提供可能改变生活的保健服务。对生殖器感染检测采取综合性的更广泛的办法也可以是一种具有成本效益的战略。BILHIV in Yourself研究是在赞比亚更广泛的女性性健康和生殖健康监测范围内，在社区检测生殖器疱疹的一种综合方法，并与护理联系起来。该项目的目标是在赞比亚的一大批妇女中验证生殖器自我取样战略，并对其进行为期三年的跟踪。在随访时，我们将测量临床进展或感染和病变的消退以及对治疗的依从性和反应。将进行一次彻底的成本效益分析，目的是找到经济上可行的办法，扩大以社区为基础的方案，将检测和护理撒哈拉以南非洲育龄妇女的生殖器疱疹、艾滋病毒、宫颈癌和其他性传播感染结合起来。

项目成果

The Presence of Hemoglobin in Cervicovaginal Lavage Is Not Associated With Genital Schistosomiasis in Zambian Women From the BILHIV Study.

• DOI: 10.1093/ofid/ofac586
• 发表时间: 2022-12
• 期刊: Open forum infectious diseases
• 影响因子: 4.2

An Update on Schistosomiasis

血吸虫病的最新进展

• DOI: 10.1016/j.clinmicnews.2023.08.001
• 发表时间: 2023
• 期刊: Clinical Microbiology Newsletter
• 作者: Payne L

Manson's Tropical Diseases

曼森热带病

• DOI: 10.1016/b978-0-7020-7959-7.00057-9
• 发表时间: 2024
• 作者: Bustinduy A