Integration of female genital schistosomiasis into HIV/sexual and reproductive health and rights and neglected tropical diseases programmes and services: a scoping review

Figures & data

Table 1. Study inclusion and exclusion criteria

Inclusion criteria	Exclusion criteria
Full text available	Full text not available
English, Spanish, Portuguese language	Not available in English, Spanish or Portuguese language
Human Studies	Animal Studies
Published up until October 2021	Published after October 2021
Peer-reviewed journal article	Non-peer-reviewed publication
Empirical research study	Non-empirical study (i.e.: case report, commentary or literature review)
Study concerns Female Genital Schistosomiasis (FGS) “a urogenital presentation of schistosomiasis that refers to the presence of S. haematobium eggs, DNA, or characteristic clinical changes specifically in the genital tract” as defined by^Citation28, p. 3)	Study does not concern FGS
Study presents elements of integration. This includes coordinated action across the different levels of care aiming to deliver health promotion, disease prevention, diagnosis, treatment, management, and rehabilitation^Citation29.	Study does not present elements of integration

Figure 1. PRISMA diagram for selection of publications²⁶

Table 2. Thematic Analysis adapted from Engels et al.²⁰

THEMES	SUB-THEMES
Activities package of measures responding to the specific needs of girls and women in relation to FGS	Awareness and Community Engagement
	Diagnosis
	Treatment & Prevention
	Burden Assessment
	Economic Evaluation
Services and Programmes: multiple public health programmes that expand or create opportunities to reach girls and women throughout their life course in relation to FGS	HIV/AIDS
	STIs
	HPV/Cervical Cancer
	Infertility
	Perinatal Care
	WASH
	Schools
	Migration

Figure 2. Tree Map summarising findings for FGS integration activities in the literature

Table 3. Summary of challenges and opportunities for FGS integration identify in the literature

	Challenges	Opportunities
Awareness and Community Engagement [3-1;6–7;10–14;19;21]	First contact girls have with information about schistosomiasis – mass drug administration (MDA campaigns in school).	Create FGS awareness programmes that link what people know about schistosomiasis to FGS.
	There is a gap in knowledge about the reproductive health implications of urogenital schistosomiasis symptoms and consequences.	Include teachers and schools in health education to overcoming barriers to prevention, treatment and break the cycle of reinfection and stigma related to FGS.
	Lack of awareness of FGS among the affected communities and health care workers.	Update nursing and other health professional training curricula to include FGS in relation to schistosomiasis, other NTDs and SRH.
	FGS and schistosomiasis are often incorrectly assumed to be sexually transmitted.	Develop and implement integrated approach to health service delivery that includes FGS in the broader symptomatic and clinical management of SRH, especially within STI and cervical cancer screening.
	FGS is commonly misdiagnosed as an STI.
	Women and girls do not seek care at standard health clinics because of the stigma associated with STIs.
Diagnosis [1;11–12, 15–18]	Urogenital schistosomiasis is not routinely screened in migrants.	Develop effective, sensitive, and affordable tools to diagnose FGS.
	No standardisation on how to diagnose FGS.	New FGS tools can be designed to work well within SRH services.
	No standard operating procedures for FGS diagnosis across health service delivery points.	Diagnosing FGS has the benefit of identifying and treating women's overall reproductive health morbidities.
	Gap related to the evidence and pathways for the inclusion of novel diagnostic tools for FGS among the wider SRH package of interventions.	Schistosomiasis and FGS risk assessment within health services serving migrants from endemic areas.
Treatment & Prevention [5–6;14]	Limitations of relying on MDA of praziquantel to school-age children, without treatment routinely provided to those outside of school age.	Recommend annual MDA for primary and secondary students to prevent FGS and prevent HIV among adolescent girls and young women.
	Clarity on the impact of treatment with praziquantel for FGS.	Expand MDA programmes beyond schools to provide praziquantel to women of all ages to prevent and treat FGS; not only to treat and prevent the SRH sequelae of FGS but also as a novel HIV and cervical cancer prevention tool.
		Health education, and interventions based on social and behavioural change science, as key to increase uptake of praziquantel and decrease risk behaviours.
Burden Assessment [2,5,9,19,22]	Consensus in the difficulty of diagnosing FGS and therefore accurately measuring the true burden, often resulting in a significant under-estimation of the disease.	Invest in measures of prevalence and burden to inform policy making, health financing, effective public health interventions and timely programmatic integration.
		Utilisation of modelling to improve estimates of burden.
		Broader case definitions of the spectrum of FGS to improve estimates including upper genital tract.
Economic Evaluation [8;20]	Gap related to the evidence on the potential socioeconomic impact of FGS integration into HIV/SRH and NTDs programmes and services.	Expand and evaluate cost-effective control and integration strategies.
		Mass preventive chemotherapy with praziquantel may be a cost-effective and cost-saving solution in preventing HIV in S. haematobium-endemic areas.
		Modelling to support estimates and scenarios for interventions.

Note: The numbers enclosed in squared brackets correspond to the articles found in the supplemental materials.

Sturt AS, Webb EL, Phiri CR, et al. Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study. PLoS Negl Trop Dis. 2020;14(7):e0008337-18. doi:10.1371/journal.pntd.0008337

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Engels D, Hotez PJ, Ducker C, et al. Integration of prevention and control measures for female genital schistosomiasis, HIV and cervical cancer. Bull World Health Organ 2020;98(9):615–624. doi:10.2471/BLT.20.252270

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