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

“相信自己”（BILHIV in YourSELF）研究是一种新颖的一站式方法，目的是在艾滋病毒和宫颈癌高发的赞比亚通过社区感染筛查改善年轻妇女的性健康和生殖健康。这项新战略的目的是在一次家访中首次整合自我抽样（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研究主要侧重于检测女性生殖器血吸虫病（FGS），这是一种慢性致残的寄生虫妇科疾病，由于其在不育、异位妊娠、阴道分泌物和性交疼痛等临床表现相似，经常与性传播疾病（STIs）混淆。在撒哈拉以南非洲，估计有4000万妇女患有FGS，其中大多数人没有意识到自己患有这种疾病。这在一定程度上是因为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撒哈拉以南非洲很少见，而该疾病在撒哈拉以南非洲很常见。小型研究表明，患有FGS的妇女感染艾滋病毒和宫颈癌的风险增加，这表明在更接近使用者的情况下，以全面和整体的方式对所有生殖器感染进行诊断的重要性。生殖器自我取样已成功地用于检测不同的生殖器感染，包括由赞比亚的主要申请人率先开展的工作，验证生殖器自我拭子用于诊断FGS。结果显示，生殖器拭子对女性生殖道寄生虫DNA检测的灵敏度可以接受，这可能首次为一种被不可接受地忽视的寄生虫病提供一种可扩展的诊断方法。此外，已使用并验证了自我抽样策略来检测人乳头瘤病毒（HPV），这是宫颈癌的致病因子，从而可能进行基于社区的筛查。所有这些感染都对南南非地区妇女的性健康和生殖健康造成严重的下游后果。因此，多病原体自我抽样和检测是一个不容错过的机会，可以在更接近用户的地方提供可能改变生活的卫生服务。对生殖器感染进行更广泛的综合检测也是一种具有成本效益的战略。在赞比亚，在更广泛的女性性健康和生殖健康监测以及与护理的联系范围内，在社区中检测艾滋病毒携带者的研究是一种整体方法。它的目标是在赞比亚的一大群妇女中验证生殖器自我抽样策略，并对其进行为期三年的跟踪调查。在随访中，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。将进行彻底的成本效益分析，以寻找经济上可行的方法来扩大基于社区的方案，这些方案将对SSA育龄妇女的FGS、艾滋病毒、宫颈癌和其他性传播感染进行综合检测和护理。

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.