The Female Genital Schistosomiasis Europe South Africa Network - VIBE-FGS

The network had five main objectives: 1. Train PhD and Masters candidates Candidates participated in validation of Schistosomiasis PCR[1] through Leiden University. They attended colposcopy workshops for female genital schistosomiasis (FGS) in 2013-2014 which were run by the Gynaecology and Infectious Diseases departments in Oslo and University of KwaZulu-Natal. PhD candidate Kleppa presented, ‘HIV target cells in the genital mucosa in patients with FGS and the effect of anti-schistosomal treatment’ at the 2013 CROI, after collaborative works between S.Africa and Denmark. 2. Investigate diagnostic and intervention strategies for FGS and HIV. Kleppa and Jourdan worked on specimens from S. Africa and Malawi to explore HIV receptors[2, 3]. Medical doctors from Zimbabwe, S. Africa and Madagascar collaborated to design an Atlas of FGS[5] and results of FGS consensus meetings were published[4]. This collaborative data collection enhanced research quality worldwide[2, 6, 7]. 3. Provide a benefit to society The S.African department of health began mass treatment campaigns in conjunction with the information collected by research partners (accepted: Frønæs SG, Randjelovica A, et al. Mass treatment of urogenital schistosomiasis in a middle income country. SA Journal of Family Medicine). To make public health recommendations we have participated in planning and making of hospital case management and WHO protocols and Department of Health policies [8]. 4. Dissemination of knowledge In addition, the partners have presented on ‘A Novel, Diagnostic Tool for FGS in Low-Resource Settings’ Holmen et al and ‘Assessment of new tools for the diagnosis of female genital schistosomiasis. Results from a field study in Madagascar Randrianasolo et al, American Society for Tropical Medicine and Hygiene. We have also held a symposium on FGS and HIV Infection: A Dangerous Relationship (Secor and Kjetland) as well as participating in more than 20 national and international meetings. 5. Sustainable work We believe this work has strengthened cooperation between partner organisations and we were awarded funding from; European Research Council (FP7/2007-2013)/ERC PIRSES-GA-2010-269245, Bill and Melinda Gates Foundation,OPPGH5344, Norwegian Research Council 213702/H10 and Helse-Sørøst no. 2012032 /2014065. 1. Pillay P, Taylor M, Zulu SG, et al. Real-time polymerase chain reaction for detection of Schistosoma DNA in small-volume urine samples reflects focal distribution of urogenital Schistosomiasis in primary school girls in KwaZulu Natal, South Africa. AJTMH 2014;90:546-52 2. Kleppa E, Ramsuran V, Zulu S, et al. Effect of female genital schistosomiasis and anti-schistosomal treatment on monocytes, CD4+ T-cells and CCR5 expression in the female genital tract. PLoS One 2014;9:e98593 3. Jourdan PM, Holmen SD, Gundersen SG, Roald B and Kjetland EF. HIV target cells in Schistosoma haematobium-infected female genital mucosa. AJTMH 2011;85:1060-4 4. Kjetland EF, Norseth HM, Taylor M, et al. Classification of the lesions observed in female genital schistosomiasis. Int J Gynaecol Obstet. 2014/09/03 ed. Vol. 127, 2014:227–228 5. Norseth HM, Ndhlovu PD, Kleppa E, et al. The colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, zimbabwe, madagascar and South Africa. PLoS Negl Trop Dis 2014;8:e3229 6. Holmen SD, Kjetland EF, Taylor M, et al. Colourimetric image analysis as a diagnostic tool in female genital schistosomiasis. Med Eng Phys 2015 7. Kleppa E, Holmen SD, Lillebo K, et al. Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa. Sex Transm Infect 2014;Accepted 8. Berge ST, Kabatereine NB, Gundersen SG, et al. Generic praziquantel in South Africa: The necessity for policy change to avail cheap, safe and efficacious schistosomiasis drugs to the poor, rural population Southern Afr J Epidemiol Infect 2011;26:22-25 Oslo University Hospital, serves a population that is both travelled and multicultural it is therefore in need of health workers who have an expertise in tropical diseases. Sørlandet Hospital serves a large population of extensively travelled Norwegians who have been seafarers and missionaries for generations. The global tourism industry is in full flourish and Norwegians are travelling more than ever exposing themselves to previously considered diseases of the tropics. The growth of tourism has meant travellers are exposed to rivers, sand, lakes, pollution, plants and food, all of which may pose a range of parasitic and bacterial agents and has lead to an infectious disease burden that did not exist even five years ago. Oslo has the largest department of Infectious diseases in Norway and its Centre for Imported and Tropical Diseases serves a as a large teaching institution, with refresher courses for clinicians, certification of specialists and regular updates on current epidemics. Clinicians regularly call for advice on inpatients and outpatients from specialists based at Oslo University Hospital. The specialists are expected to be experts in all areas of imported and tropical diseases and therefore it is vital to have continued professional development. The study population which was included in the research consists of school aged teenagers and children. The scientists who form the research collaborative are therefore expected to appropriately relate to parents, teachers, friends and families. They also expected to be able to explain sensitive information in simple non-jargon language in participants for whom English may not be their first language. Due to the nature of the project, sexual abuse, issues around confidentiality, HIV in the young and cancer are all part of daily life for the nurses and doctors who have clinical duties as well as their research questions. The young study participants raise a number of social and ethical problems which push visiting scientists and clinicians to handle difficult situations. The skills that the clinicians are able to gain from the research project are ones that they can easily transfer to their roles in their home countries. Communication skills are vital and the development of these will directly aid patient-doctor consultations in clinicians’ home institutions. The roles that visiting scientists are expected to fill test and greatly improve their skills in problem solving, computer literacy, time management, human resources management and academia. Researchers constantly have to consult, form liaisons with strangers, negotiate time and resources. This research grant has been instrumental in giving experience in third world medicine for more than 30 Masters’ students, 6 PhD candidates and senior researchers. Researchers have now gone into clinical practice, teaching, deliberations with the health authorities such as the WHO and in implementing local policies for case management at their home institutions. The project works across disciplines of infectious diseases, public and global health, urology, paediatrics, venereology, gynaecology, and internal medicine.The network of contacts in the foreign institutions we have collaborated with will serve as a basis for medical consultations, as a resource pool for teaching and as collaborators and advisors for future projects.