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

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...

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Autores principales: 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, J. Russell, Hayes, Richard, Ayles, Helen, Hansingo, Isaiah, van Lieshout, Lisette, Bustinduy, Amaya L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360036/
https://www.ncbi.nlm.nih.gov/pubmed/32663222
http://dx.doi.org/10.1371/journal.pntd.0008337
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author 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, J. Russell
Hayes, Richard
Ayles, Helen
Hansingo, Isaiah
van Lieshout, Lisette
Bustinduy, Amaya L.
author_facet 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, J. Russell
Hayes, Richard
Ayles, Helen
Hansingo, Isaiah
van Lieshout, Lisette
Bustinduy, Amaya L.
author_sort Sturt, Amy S.
collection PubMed
description 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.
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spelling pubmed-73600362020-07-23 Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study 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, J. Russell Hayes, Richard Ayles, Helen Hansingo, Isaiah van Lieshout, Lisette Bustinduy, Amaya L. PLoS Negl Trop Dis Research Article 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. Public Library of Science 2020-07-14 /pmc/articles/PMC7360036/ /pubmed/32663222 http://dx.doi.org/10.1371/journal.pntd.0008337 Text en © 2020 Sturt et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
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, J. Russell
Hayes, Richard
Ayles, Helen
Hansingo, Isaiah
van Lieshout, Lisette
Bustinduy, Amaya L.
Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study
title Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study
title_full Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study
title_fullStr Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study
title_full_unstemmed Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study
title_short Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study
title_sort genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in zambian women: the bilhiv study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360036/
https://www.ncbi.nlm.nih.gov/pubmed/32663222
http://dx.doi.org/10.1371/journal.pntd.0008337
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