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

Abstract

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.