Hashini Nilushika Galappaththi-Arachchige

PhD 2019

Elisabeth Kleppa

PhD 2015

Graduated as a medical doctor from the University of Bergen, Norway in 2007, Kleppa completed her PhD in 2015. She worked as a medical doctor at Bærum Hospital, Norway, before she did her Diploma in Tropical Medicine and Hygiene (DTM&H) at the Liverpool School of Tropical Medicine in 2009. Her research focuses on the biological mechanisms behind the association between HIV and FGS.

Summary

More than 110 million Africans are estimated to be infected with Schistosoma (S.) haematobium, but it is still one of the so-called “neglected tropical diseases”. Poor countries bear the majority of the disease burden, contributing to the maintenance of the cycle of poverty.

In Africa, women are at a higher risk of human immunodeficiency virus (HIV) infection than men, and this cannot be explained by behavioural factors alone. Biological risk factors seem to contribute to the differences in HIV prevalence between geographical regions and genders. This thesis will focus on female genital schistosomiasis and cervical ectopy, both factors hypothesised to facilitate the transmission of HIV through the genital mucosa. Genital schistosomiasis in women is characterized by lesions referred to as “sandy patches” that appear grainy or homogenous and are thought to be caused by the deposition of ova in the genital tissues. Sandy patches are often associated with abnormal mucosal blood vessels and contact bleeding due to the fragile mucosa. Cervical ectopy and female genital schistosomiasis (FGS) may be diagnosed by photocolposcopic examination, and both conditions are likely to be present before sexual debut. In addition to increased susceptibility to HIV infection, S. haematobium infection has been suggested to accelerate the progression of HIV infection, possibly through increased immune activation.

In this study, South African women attending high schools in KwaZulu-Natal were included. Blood, urine and cervical lavage samples were collected and a photo-colposcopic examination performed.

We found that FGS was associated with a higher frequency of HIV target cells and HIV co-receptor expression in the genital compartment (the proportion of CD14+CCR5+ cells was higher in FGS positive (FGS+) than FGS-negative (FGS-), p = 0.036) and in blood (both the proportions of CD14+ cells (p = 0.042), and CD4+CCR5+ cells (p = 0.018) were higher in FGS+). Furthermore, praziquantel treatment decreased the proportion of HIV target cells in FGS-positive women. Both the CD14+ cell population and CCR5 expression by CD4+ cells decreased significantly in both compartments after anti-schistosomal treatment (p = 0.043 and 0.025, respectively). We found no significant difference in CD4 cell counts in women with or without S. haematobium infection. Furthermore, we found that cervical ectopy was associated with the prevalence of chlamydia infection (adjusted OR 1.78, p = 0.033) and with HIV infection in the youngest study subjects (OR 2.19, p = 0.014).

Future studies are needed to show whether treatment of schistosomiasis and/or intervention against cervical ectopy may become tools in the battle against the HIV epidemic.
Dr Kleppa is a recipient of grant from the South Eastern Norway Health Authority

Sigve Holmen

PhD 2017

Graduated as a medical doctor from the University of Oslo, Norway in 2009. Holmen worked as a University Lecturer for the University of Oslo and as a medical doctor in Harding Hospital. His PhD work explores computerised image analysis as a new tool in diagnosing female genital schistosomiasis in low-resource settings.

Summary

Mobile phones can now be used to diagnose the world’s second most common tropical disease after malaria! By taking pictures of the patient’s mucous membranes where the parasite has laid its eggs, computer image analysis can diagnose female genital schistosomiasis.

There are no good diagnostic tools for female genital schistosomiasis. We therefore wanted to find a simple, objective and automated way to diagnose this disease using digital image analysis. Our goal is to pave the way for a digital diagnostic tool that can be used in areas with little resources and a lack of health professionals with expertise in tropical medicine. Diagnostics in the form of software is easy to distribute – even to remote areas of Africa, thanks to the mobile revolution in recent years. The tool could be used on a variety of devices such as mobile phones, tablets, computers, or other, in the form of an “app” that you install.

We used colour analyses to identify the yellow areas characteristic of female genital schistosomiasis. In addition, we used image analysis to identify and characterise the abnormal blood vessels surrounding the lesions.We found that these are typical because they tend to appear in a circular configuration and that they have a more complex form than other abnormal blood vessels.

This automated digital image analysis represents the first step towards developing a diagnostic tool for use in areas where this disease is prevalent. Further research is needed to investigate how this tool can best be implemented in these areas and how well the diagnostic accuracy is in a real clinical situation.

Pavitra Pillay

PhD 2016

Pillay graduated as a Medical Technologist in 1992 and worked as a cytotechnologist at Regional Laboratory Services, KZN, South Africa, before joining Durban University of Technology where she currently lectures to Medical Technology students. In 2004 she attained a Masters in Public Health from University of KwaZulu-Natal. Her research focuses on genital schistosomiasis as a risk factor for cervical  cancer and on developing laboratory based diagnostic tools for FGS.

Nonhlahla Mbhata

PhD 2017

Graduated with M Med Sci (Medical Microbiology) from the University of KwaZulu-Natal, Durban, South Africa in 1999. She worked as a medical technologist in the pathology laboratory at the Edendale Hospital in Pietermaritzburg, South Africa before she joined Durban University of Technology in June 2003 where she is currently working. Her PhD focused on the high-risk HPV types distribution and persistence in young women in KwaZulu-Natal, South Africa and it also includes a study on self-sampling acceptability by young women in the same region.