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Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study

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Sturt, Amy S., Webb, Emily L., Phiri, Comfort R., Mweene, Tobias, Chola, Namakau, van Dam, Govert J., Corstjens, Paul L. A. M., Wessels, Els, Stothard, Russell ORCID: https://orcid.org/0000-0002-9370-3420, Hayes, Richard, Ayles, Helen, Hansingo, Isaiah, van Lieshout, Lisette and Bustinduy, Amaya L. (2020) 'Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study'. PLoS Neglected Tropical Diseases, Vol 14, Issue 7, e0008337.

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Abstract

Background: Given the potentially causal association of female genital schistosomiasis (FGS) with HIV-1 infection, improved diagnostics are urgently needed to scale-up FGS surveillance. The BILHIV (bilharzia and HIV) study assessed the performance of home-based self-collection methods (cervical and vaginal swabs) compared to cervicovaginal lavage (CVL) for the detection of Schistosoma DNA by real-time polymerase chain reaction (PCR). Methods: Between January and August 2018, a consecutive series of female participants from the Population-Cohort of the previous HIV prevention trial HPTN 071 (PopART), resident in Livingstone, Zambia were invited to take part in BILHIV if they were 18–31 years old, non-pregnant and sexually active. Genital self-collected swabs and a urine specimen were obtained and a questionnaire completed at home visits. CVL was obtained at clinic follow-up. Results: 603 women self-collected genital swabs. Of these, 527 women had CVL performed by a mid-wife during clinic follow-up. Schistosoma DNA was more frequently detected in genital self-collected specimens (24/603, 4.0%) compared to CVL (14/527, 2.7%). Overall, 5.0% (30/603) women had female genital schistosomiasis, defined as a positive PCR by any genital sampling method (cervical swab PCR, vaginal swab PCR, or CVL PCR) and 95% (573/603) did not have a positive genital PCR. The sensitivity of any positive genital self-collected swab against CVL was 57.1% (95% CI 28.9–82.3%), specificity 97.3% (95.5–98.5%). In a subset of participants with active schistosome infection, determined by detectable urine Circulating Anodic Antigen (CAA) (15.1%, 91/601), positive PCR (4.3%, 26/601), or positive microscopy (5.5%, 33/603), the sensitivity of any positive self-collected specimen against CVL was 88.9% (51.8–99.7%). Conclusions: Genital self-sampling increased the overall number of PCR-based FGS diagnoses in a field setting, compared with CVL. Home-based sampling may represent a scalable alternative method for FGS community-based diagnosis in endemic resource limited settings.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 810 Schistosomiasis
WJ Urogenital System > WJ 100 General works
WJ Urogenital System > WJ 140 Urologic diseases (General)
WP Gynecology > Anatomy. Diseases. Injuries > WP 141 Examination. Diagnosis. Diagnostic methods. Monitoring
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pntd.0008337
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 15 Jul 2020 11:04
Last Modified: 03 Aug 2020 09:29
URI: https://archive.lstmed.ac.uk/id/eprint/15042

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