Acceptability and feasibility of genital self-sampling for the diagnosis of female genital schistosomiasis: a cross-sectional study in Zambia

<ns4:p><ns4:bold>Background</ns4:bold>: 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 <ns4:italic>Schistosoma haematobium</ns4:italic>. 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</ns4:p><ns4:p> (BILHIV) study evaluated home self-sampling genital collection methods for the diagnosis of FGS.</ns4:p><ns4:p> <ns4:bold>Methods</ns4:bold>: Eligible participants included non-pregnant, sexually active women aged 18-31 who were previously recruited for the HPTN 071</ns4:p><ns4:p> (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.</ns4:p><ns4:p> <ns4:bold>Results</ns4:bold>: 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%</ns4:p><ns4:p> (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%</ns4:p><ns4:p> (279/603) and need for transportation 15.9% (96/603).</ns4:p><ns4:p> <ns4:bold>Conclusions</ns4:bold>: Home based genital self-sampling for FGS diagnosis is highly acceptable. This scalable method may inform future efforts for community-based diagnosis of FGS.</ns4:p>