Stakeholders Perspective of Integrating Female Genital Schistosomiasis into HIV Care: A Qualitative Study in Ghana

Background In Sub-Saharan Africa (SSA), HIV infection is the main factor contributing to adult premature death. The prevalence of HIV in the region could also be associated with recent increases in Female Genital Schistosomiasis (FGS) globally. The fast-rising prevalence of FGS in SSA nations including Ghana, which has led to the emergence of dual HIV-FGS conditions, provides evidence of the trend. As such the WHO is advocating for integrated services of HIV and FGS care. This study explored stakeholders’ perspectives of the integration of prevention and control measures for Female Genital Schistosomiasis and HIV care in FGS endemic settings in Ghana. Methods The study was conducted in the Ga South Municipality in the Greater Accra region of Ghana. Using qualitative research methods, Focus Group Discussion was conducted with Community Health Officers (n=9) and Key Informant Interviews with stakeholders including health care professionals and providers at the Regional, District and community levels (n=13) to explore the feasibility, challenges, and opportunities of integrating FGS prevention and control package with HIV continuum of care in communities. In-depth interviews were also conducted among Persons with FGS and HIV (n=13), Female Households (n=10), Community Health Management Committee members and Community leader (n=7) to explore their views on the facilitators and barriers of the integration of FGS into HIV care into the Primary Health Care (PHC) in Ghana. All study participants were purposively sampled to achieve the study objective. All audio-recorded data were transcribed verbatim, a codebook developed, and the data was thematically analysed with the aid of NVivo software version 13. Results The study identified a knowledge gap regarding Female Genital Schistosomiasis (FGS) compared to HIV. The majority of Community Health Officers (CHOs) exhibited limited knowledge about FGS. Additionally, health workers misconstrued FGS as sexually transmitted infections. Community members who expressed knowledge of FGS were about gynecological symptoms of FGS. Three main health outlets; health facilities, herbal centers, and spiritual centers are utilized either concurrently or in sequence. This health seeking behaviour negatively affected the early detection and management of FGS among HIV clients. Integration of HIV and FGS may be affected by the limited awareness and knowledge, resource constraints, stigma and discrimination, healthcare providers’ attitudes and practices, and cultural beliefs. Conclusions The study finds that knowledge of FGS was usually low among both community members and Community Health Officers. This was having a detrimental effect on regular screening of females for genital schistosomiasis. Integration of FGS and HIV has the potential to help Ghana achieve HIV eradication; however, before such a program is launched, implementation barriers such as stigma, knowledge gap, unavailability of needed logistics at health facilities, shortage of FGS and HIV drugs and issues of accessibility of drugs must be addressed. The results also imply that forming alliances and working together with various community health care professionals may help with early HIV and FGS diagnosis and treatment. Finally, there is the pressing need to develop a clinical protocol for FGS and HIV integration and training of community health workers on how to apply the protocol.