# Stakeholders perspective of integrating female genital schistosomiasis into HIV care: A qualitative study in Ghana

## TL;DR

This study explores challenges and opportunities for integrating FGS and HIV care in Ghana, highlighting knowledge gaps and barriers like stigma and resource shortages.

## Contribution

The study provides stakeholder insights into integrating FGS and HIV services in Ghana, emphasizing the need for training and clinical protocols.

## Key findings

- Community Health Officers and community members showed limited knowledge of FGS, often misclassifying it as an STI.
- Barriers to integration included stigma, cultural beliefs, provider attitudes, and resource shortages.
- Training health workers and developing standardized protocols are essential for effective FGS-HIV integration.

## Abstract

In Sub-Saharan Africa (SSA), HIV remains the leading cause of adult premature death. The rising prevalence of Female Genital Schistosomiasis (FGS) in SSA, including Ghana, has led to a growing dual burden of HIV-FGS cases. This trend has prompted the WHO to advocate for integrated HIV and FGS services. This study examined stakeholder perspectives on integrating FGS prevention and control with HIV care in endemic areas of Ghana.

The study took place in Ga South Municipality, Greater Accra Region, Ghana. A qualitative approach combining narrative and phenomenological designs was used. Data collection included Focus Group Discussions with Community Health Officers (CHOs) (n = 9), and Key Informant Interviews with healthcare providers at regional, district, and community levels (n = 13). In-depth interviews were also conducted with individuals affected by FGS and HIV (n = 13), female household members (n = 10), Community Health Management Committee members, and community leaders (n = 7). Participants were purposively selected. Audio-recorded interviews were transcribed, coded, and thematically analyzed using NVivo version 13.

There was a notable knowledge gap on FGS among CHOs and community members. Many health workers mistook FGS for sexually transmitted infections, while community members primarily recognized it through gynecological symptoms. Healthcare was sought from a mix of formal health facilities, herbalists, and spiritual centers, often delaying accurate diagnosis and management. Barriers to integrating HIV and FGS services included limited awareness, stigma, cultural beliefs, provider attitudes, and resource shortages.

Both CHOs and community members lacked sufficient knowledge about FGS, hindering regular screening and timely diagnosis. While integrating FGS and HIV care could support Ghana’s HIV eradication goals, success depends on addressing stigma, improving awareness, ensuring drug availability, and equipping health facilities. Collaboration among healthcare professionals and developing standardized clinical protocols are essential. Training community health workers on these protocols is urgently needed to support effective integration.

In Sub-Saharan Africa (SSA), HIV remains a leading cause of premature adult death. Recent data suggest a link between rising HIV prevalence and the global increase in Female Genital Schistosomiasis (FGS), particularly in SSA countries like Ghana. The emergence of co-existing HIV-FGS cases has prompted the World Health Organization (WHO) to call for integrated services. This study explored stakeholder perspectives on integrating FGS prevention and control with HIV care in endemic areas of Ghana, specifically the Ga South Municipality in the Greater Accra Region. Qualitative interviews and discussion were conducted with Community Health Officers, healthcare stakeholders, individuals living with FGS, female household members, and community leaders. Participants were purposively selected, and data were thematically analyzed using NVivo 13. Findings revealed limited knowledge of FGS among both community members and health workers, with frequent misclassification of FGS as a sexually transmitted infection. Barriers to integration included stigma, resource shortages, provider attitudes, and cultural beliefs. The study recommends developing clinical protocols, training health workers, and enhancing collaboration to support early detection and integrated care for FGS and HIV.