The Zipima Weka Schista Study (Do self-testing sister!) longitudinal cohort study

The 'Zipime Weka Schista!' (Do self-testing sister!) study is a novel one-stop approach for improving young women's sexual and reproductive health through community-based infection screening in Zambia, a country known to have a high prevalence of HIV and cervical cancer. This novel strategy aims to integrate, in a single home visit and for the first time, self-sampling (genital and oral swabs) for the detection of multiple genital infections with serious consequences for female's sexual and reproductive health. The Zipime Weka Schista! study mainly focuses on the detection of female genital schistosomiasis (FGS), a chronic and disabling parasitic gynaecological disease that gets often confused with sexually transmitted diseases (STIs) due to their similarities in clinical presentations such as infertility, ectopic pregnancies, vaginal discharge and pain with coitus. An estimated 40 million women suffer from FGS in sub-Saharan Africa, and most of them are unaware of harbouring the disease. This is partly because the detection of FGS is challenging, as it relies on expensive equipment and expertise that are seldom available in sub-Saharan Africa, where the disease is common. Small studies have documented an increased risk of acquiring HIV and cervical cancer in women with FGS, underlying the importance of approaching diagnosis of all genital infections comprehensively and holistically, closer to the user.

With over 2500 women enrolled, the Zipime Weka Schista! study constitutes the largest cohort study of a one-stop genital multi-pathogen screening in Zambia to date. Home-based self-sampling study procedures were widely accepted by the recruited participants, making this approach a feasible strategy for scaling up the integration of multi-pathogen screening, as was postulated in the initial hypothesis. Further preliminary results reveal a high prevalence of FGS and STIs including human papillomavirus (HPV) HIV and Trichomonas. The success of the first part of this UKRI Future Leaders Fellowship is a testament to the steady leadership of the FLF fellow and the strong partnership with Zambart, the overseas institution.

For the second part of the FLF, the work will focus on further longitudinal investigation of long-term outcomes of the prevalent co-morbidities including cervical cancer. A sustainable screening pathway will be developed based on the laboratory and clinical results. A thorough ongoing cost-effectiveness analysis will aim to find economically feasible ways to scale up community-based programmes that will integrate the detection and care of FGS, HIV, cervical cancer and other STIs for women of reproductive age in Zambia. Results can also help inform programmes in similar settings across SSA.