Alison Krentel ^1,2* Kazeem Arogundade ² Mbolatina Raharinivo ^3,4 Joseph Opare ⁵ Clara F. Rasoamanamihaja ⁶ Randrianasolo F. Harinianina ^3,4 Maxwell Dalaba ⁷ Mustapha Immurana ⁷ Isis Umbelino-Walker ⁸ Caroline Pensotti ^8,9 Moussa Sangare ¹ Kruti Patel ¹ Julie Jacobson ⁸ Margaret Gyapong ⁷

• ¹ University of Ottawa, Ottawa, Canada
• ² Bruyere Research Institute, Ottawa, Ontario, Canada
• ³ K'Ola Vanona Association, Antananarivo, Madagascar
• ⁴ National Institute of Public and Community Health, Ministry of Public Health, Antananarivo, Madagascar
• ⁵ Neglected Tropical Diseases Program, Disease Control Unit, Public Health Division, Ghana Health Service, Accra, Ghana
• ⁶ Neglected Tropical Diseases Program, Ministry of Public Health, Antananarivo, Madagascar
• ⁷ University of Health and Allied Sciences, Ho, Volta, Ghana
• ⁸ Bridges to Development, Geneva, Switzerland
• ⁹ Unlimit Health, London, United Kingdom

Women and girls who have been infected with the blood fluke Schistosoma haematobium can experience the chronic form of urogenital schistosomiasis, called female genital schistosomiasis (FGS). Some FGS symptoms resemble sexually transmitted infections. As a result, women and girls seeking treatment are often misdiagnosed and stigmatized. The FGS Accelerated Together (FAST) Package project implemented a holistic approach to address FGS combining proven interventions in training, mass drug administration, diagnosis, and treatment as well as community awareness to address FGS in four selected districts in Ghana and Madagascar. The FAST Package was supported by an FGS National Committee who provided guidance on integration at the national level. Using an implementation research design, researchers worked closely with government counterparts in the programs for neglected tropical diseases in both countries. Baseline crosssectional surveys and qualitative methodologies collected information on schistosomiasis and FGS awareness, experience with health seeking behaviors and knowledge of schistosomiasis prevention amongst community members and teachers. FAST Package interventions included healthcare provider training delivered in online and in person formats; development of an Educators' booklet to support schistosomiasis/FGS awareness creation among teachers,healthcare providers and community members; suspected FGS case detection; and advocacy for the provision of praziquantel in the primary health care system. Endline results included a cross sectional survey and qualitative methodologies amongst community members and teachers, including Photovoice for women of reproductive health age exposed to FGS. This paper presents a description of the FAST Package project, its approach, and selected results from the implementation of research and interventions in both countries. The FAST Package demonstrated the value of a holistic approach to address FGS, highlighting some of the challenges and opportunities for integration within the health system.