Mapping Schistosoma haematobium for Novel Interventions against Female Genital Schistosomiasis and Associated HIV Risk in KwaZulu-Natal, South Africa

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  • 1 Department of Infectious Diseases Ullevaal, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway;
  • 2 Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
  • 3 Department of Biomedical and Clinical Technology, Durban University of Technology, Durban, South Africa;
  • 4 Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa;
  • 5 Centre for Clinical Research, Ullevaal University Hospital and Medical Faculty, Oslo, Norway;
  • 6 BRIGHT Academy, Ugu, South Africa;
  • 7 Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;
  • 8 Institute for Global Development and Planning, University of Agder, Kristiansand, Norway

Women with female genital schistosomiasis (FGS) have been found to have genital symptoms and a three-fold higher risk of HIV infection. Despite WHO recommendations, regular antischistosomal mass drug administration (MDA) has not yet been implemented in South Africa possibly because of the lack of updated epidemiological data. To provide data for future prevention efforts against FGS and HIV, this study explored Schistosoma haematobium prevalence in girls and young women and the effects of antischistosomal MDA, respectively. Urinary schistosomiasis and genital symptoms were investigated in 70 randomly selected secondary schools in three districts within KwaZulu-Natal and 18 primary schools. All study participants were treated for schistosomiasis, and schools with the highest urinary prevalence were followed up after 1 and 4 years of MDA. At baseline, urine analysis data showed that most schools were within the moderate-risk prevalence category where biennial antischistosomal MDA is recommended, as per WHO guidelines. Young women had high prevalence of genital symptoms (36%) after correcting for sexually transmitted infections. These symptoms may be caused by infection with schistosomes as FGS cannot be diagnosed by urine analysis alone. In KwaZulu-Natal rural schools, this study suggests that antischistosomal MDA with praziquantel could prevent genital symptoms in more than 200,000 young women. Furthermore, it is feasible that more than 5,000 HIV infections could be prevented in adolescent girls and young women by treatment and prevention of FGS.

Author Notes

Address correspondence to Eyrun F. Kjetland, Department of Infectious Diseases Ullevaal, Norwegian Centre for Imported and Tropical Diseases, Institute of Clinical Medicine, P.O. Box 4956, Nydalen, Oslo 0424, Norway. E-mail: e.f.kjetland@medisin.uio.no

Financial support: Financial support was provided by the European Research Council under the European Union's Seventh Framework Programme (FP7/2007–2013/ERC Grant agreement no. PIRSES-GA-2010-269245); the South-Eastern Norway Regional Health Authority (network project no. 2011073); the University of Copenhagen with the support from the Bill & Melinda Gates Foundation (Grant # OPPGH5344); the Norwegian Research Council (ref 213702/H10); P. C. Flu Foundation, Oslo University Hospital Ullevaal, the Norwegian Centre for Imported and Tropical Diseases, Oslo, Norway; and the National Research Foundation, South Africa.

Authors’ addresses: Mahala Livingston, Department of Infectious Diseases Ullevaal, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway, and Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University of Louisiana, New Orleans, LA, E-mail: mahalalivingston@gmail.com. Pavitra Pillay, Department of Biomedical and Clinical Technology, Durban University of Technology, Durban, South Africa, E-mail: pillayp@dut.ac.za. Siphosenkosi Gift Zulu, Jane Dene Kvalsvig, Silindile Gagai, and Myra Taylor, Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, E-mail: zulus3@ukzn.ac.za, kvalsvigj@ukzn.ac.za, sliegagai@hotmail.com, and taylor@ukzn.ac.za. Leiv Sandvik, Centre for Clinical Research, Ullevaal University Hospital and Medical Faculty, Oslo, Norway, E-mail: uxledv@ous-hf.no. Nilushika Galappaththi-Arachchige and Elisabeth Kleppa, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway, E-mails: hashiniga@gmail.com and elklep@ous-hf.no. Patricia Ndhlovu, Centre for Bilharzia and Tropical Health Research, BRIGHT Academy, Ugu, South Africa, E-mail: patriciandhlovu5@gmail.com. Birgitte Vennervald, Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, E-mail: bjv@sund.ku.dk. Svein Gunnar Gundersen, Institute for Global Development and Planning, University of Agder, Kristiansand, Norway, E-mail: s.g.gundersen@uia.no. Eyrun F. Kjetland, Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway, and Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa, E-mail: e.f.kjetland@medisin.uio.no.

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