Feasibility and Acceptability of Point-of-Care Testing for Sexually Transmitted Infections in Outpatient Clinics Offering Integrated Services in Eswatini.

BACKGROUND

Lack of point-of-care testing (POCT) for sexually transmitted infections (STIs) is a continuing missed opportunity in Sub-Saharan Africa. We assessed feasibility and acceptability of STI POCT in Eswatini.

METHODS

Sexually transmitted infection POCT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) was piloted among sexually active adults 18 to 45 years old attending 2 urban outpatient clinics offering integrated services. Women were randomized 1:1 to provide urine or vaginal swab, and all men provided urine samples for CT/NG testing using Cepheid CT/NG cartridges on existing GeneXpert platforms. Results were returned in-person or by telephone call. We assessed duration of procedures, participant and health care worker acceptability of services (5-point Likert scale), time spent on STI POCT services, and correlates of CT/NG infection.

RESULTS

Of 250 adults triaged, 99% (248 of 250) accepted STI POCT, including 44% (109 of 248) people living with HIV. Sexually transmitted infection POCT procedures took a median of 3:22 hours. Most adults (90% [224 of 248]) received results within a day (61% same day, 29% next day). CT/NG was detected among 22% (55 of 248): 31 of 55 CT, 21 of 55 NG, and 3 of 55 coinfections. Youth 18 to 25 years old, history of any sexual intercourse, and condomless sex within the previous 7 days were significantly associated with CT/NG detected ( P < 0.05). Most adults with CT/NG were treated (51 of 55 [93%]). Most participants were satisfied with STI POCT (217 of 241 [90%]) and would accept again/recommend it. All 32 health care workers who participated were satisfied with STI POCT.

CONCLUSIONS

Sexually transmitted infection POCT was feasible, acceptable, and identified a high prevalence of STIs, highlighting the urgent need for this testing.