Protected: Is FGS-SRHR Integration possible?

Is providing female genital schistosomiasis (FGS) services as part of broader SRHR interventions acceptable to women and girls? Is it feasible to implement? What are the cost implications? And if it can be done, what is the best way to share these lessons? 

These were some of the guiding questions for the FGS Integration Project, which also looked From the data which LVCT Health collected, integrating FGS into sexual and reproductive health and rights interventions (SRHR) isn’t just ‘possible’, but that it is vital.

If left untreated, FGS can lead to infertility and increases the risk of HIV, Human Papilloma Virus (HPV) and cervical cancer. It is often misdiagnosed and misunderstood, as well as under-reported and under-researched. Which is why findings from the integration pilot in Kenya demonstrate the acceptability and success of FGS-SRHR integration have the potential to meet the needs of the millions of girls and women affected by this neglected condition.

Integrating HIV and Female Genital Schistosomiasis (FGS) Services 

The FGS integration project set out to examine how prevention, diagnosis, and treatment can be integrated into sexual and reproductive health and rights interventions, budgets and policies, both nationally and locally. It ​defined and piloted a ‘minimum service package’ for FGS-SRHR integration and then assessed the ‘feasibility, acceptability, and cost’ of FGS and SRHR integration. The project, which runs from March 2023 to July  2025, was carried out in Homa Bay, Kwale and Kilifi. These are all Kenyan counties with high prevalence of schistosomiasis. 

This is particularly important given the current climate for health funding, as Ronald Tibiita, Lead: programmes at Frontline AIDS explains. 

“With shrinking funding globally, it is becoming more important that we should integrate healthcare service delivery. There is an increasing need for integration of healthcare services because financial resources are shrinking every day, and donors are cutting external funding.” 

Integration is feasible because it provides the most practical care. This is particularly true in areas where transport can be a challenge. 

“A woman might travel 50-60 kilometres for HIV testing. You can’t expect her to come back to the clinic tomorrow and test again for FGS. She doesn’t have that time,” says Ronald.

A number of women with FGS had previously been misdiagnosed with an STI or cervical cancer due to the way that FGS clinically presents. So an indirect outcome can include the identification of cervical  cancer, as  Delphine Schlosser, a Senior Adviser on the project, explains:

“FGS screening can be particularly well integrated with cervical cancer screening as both require a pelvic exam. So it makes sense for health workers to check FGS lesions when they do pelvic exams, which they do already for cervical cancer screening.”

For this work to be practical, there needs to be the right resources in place to deliver services. The project, which was funded by the Children’s Investment Fund Foundation (CIFF) and delivered in partnership with LVCT Health and Bridges to Development, trained 400 healthcare workers and 345 community health workers.  

As a result, just under 56,000 women received integrated FGS–SRHR services during the project, including health literacy at a cost of just $0.5 per woman. Of these, 8,856 women were screened for FGS, of whom 2,441 were diagnosed with confirmed FGS positive and treated with praziquantel, at a cost of $10.3 per woman. 

Sustaining – and ultimately scaling up – this integrated approach however requires action at national and global levels. This includes developing normative guidelines, developing indicators to record cases, ensuring the adequate funding and supply of treatment, developing training curricula and guidelines and embedding FGS into health worker and local level health planning training. 

The study research suggests that FGS should be included in healthcare training because being able to screen and diagnose for FGS reduces the risk of misdiagnosis, mistreatment, antimicrobial resistance, and the costs to women, their households and the health system. 

“As well as research visits, we reviewed records in HIV, cancer, and antenatal clinics. Because of integration, health workers were able to see more women. We have the data, explains Ronald. “We have demonstrated it’s possible to integrate. What we need to do now is to scale up.”