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

IntroductionSelf-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. MethodsNested 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. ResultsOverall, 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. ConclusionDespite a preference for provider-collection, SCS are acceptable among adults in this setting and support expanded access to STI diagnostic services. Key QuestionsO_ST_ABSWhat is already known on this topicC_ST_ABSTimely 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 addsWe 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 policyPatient 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.