The Acceptability of Self-Collected Samples for STI Testing: A Qualitative Study Among Adults in Rakai, Uganda

Abstract

Introduction Self-collected samples (SCS) for sexually transmitted infection (STI) testing have been shown to be feasible and acceptable in high-resource settings. However, few studies have assessed the acceptability of SCS for STI testing in a general population in low-resource settings. This study explored the acceptability of SCS among adults in south-central Uganda.

Methods Nested within the Rakai Community Cohort Study, we conducted semi-structured interviews with 36 symptomatic and asymptomatic adults who self-collected samples for STI testing. We analyzed the data using an adapted version of the Framework Method.

Results Overall, participants did not find SCS physically uncomfortable. Reported acceptability did not meaningfully differ by gender or symptom status. Perceived advantages to SCS included increased privacy and confidentiality, gentleness, and efficiency. Disadvantages included the lack of provider involvement, fear of self-harm and the perception that SCS was unhygienic.Most participants preferred provider-collected samples to SCS. Nevertheless, almost all said they would recommend SCS and would do it again in the future.

Conclusion Despite a preference for provider-collection, SCS are acceptable among adults in this setting and support expanded access to STI diagnostic services.

What is already known on this topic Timely diagnosis is critical for STI control, with testing being the gold standard for diagnosis. Self-collected samples (SCS) for STI testing offer an opportunity to expand STI testing services and are well accepted in high-resource settings. However, patient acceptability of self-collected samples in low-resource settings is not well described.

What this study adds We found that SCS was acceptable to both male and female participants in our population, regardless of whether they reported STI symptoms. Perceived advantages to SCS included: increased privacy and confidentiality, gentleness, and efficiency; disadvantages included lack of provider involvement, fear of self-harm and the perception that SCS was unhygienic. Overall, most participants preferred provider collection over SCS.

How this study might affect research, practice or policy Patient education addressing perceived disadvantages may increase SCS acceptability and support the use of SCS as a means to identify cases and control STIs in low-resource settings.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work was supported by the Fogarty-Fulbright Fellowship in Public Health; the Johns Hopkins Center for Global Health; the Johns Hopkins Center for Qualitative Studies in Health and Medicine; the Hopkins Population Center via the National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development under Grant R24HD042854; and The Alliance for a Healthier World. STIPS was supported by the Johns Hopkins Center for AIDS Research and the National Institutes of Health/National Institute of Allergy and Infectious Diseases under Grant 1P30AI094189.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Board of Johns Hopkins Medicine (IRB00204691; July 9, 2019), the Research and Ethics Committee of the Uganda Virus Research Institute (GC/127/19/07/709; July 19, 2019) and the Uganda National Council for Science and Technology (HS364ES; June 6, 2019) gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Footnotes

Conflicts of interest and sources of funding: The authors declare no competing interest. This work was supported by the Fogarty-Fulbright Fellowship in Public Health; the Johns Hopkins Center for Global Health; the Johns Hopkins Center for Qualitative Studies in Health and Medicine; the Hopkins Population Center via the National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development under Grant R24HD042854; and The Alliance for a Healthier World. STIPS was supported by the Johns Hopkins Center for AIDS Research and the National Institutes of Health/National Institute of Allergy and Infectious Diseases under Grant 1P30AI094189.

Data Availability

All data produced in the present study are available upon reasonable request to the authors.

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