Towards the development of an acceptable and user-friendly self-sampling intervention for diagnosing sexually transmitted infections among young women in eThekwini District Municipality, South Africa

Abstract

BACKGROUND : Sexually transmitted infections (STIs) remain a major global health issue, disproportionately affecting young women, despite healthcare advancements. South Africa, particularly KwaZulu-Natal Province, has the highest STI prevalence in sub-Saharan Africa. The current syndromic management approach faces challenges that deter young women from seeking care. Self-sampling interventions are promising solutions, being user-friendly and effective for detecting both symptomatic and asymptomatic infections. This thesis aims to understand young women's preferences for self-sampling approaches towards the development of a user-friendly self-sampling intervention to diagnose STIs in young women, to promote uptake and improve health outcomes. The study focused on young women in the eThekwini Metropolitan Municipality, South Africa. METHODS : We employed a sequential exploratory design and a mixed-method approach across multiple phases. Initially, a scoping review mapped evidence on self-sampling interventions for STIs in women, informing the study's objectives. The second phase involved a systematic review and meta-analysis to compare the diagnostic accuracy of self-collected specimens with those collected by healthcare workers. In the third phase, the nominal group technique (NGT) identified barriers to clinic-based STI healthcare and key attributes for a self-sampling intervention. Finally, a discrete choice experiment (DCE) was conducted to understand young women's preferences based on the identified attributes. The findings were synthesised to develop an acceptable and user-friendly self-sampling intervention for young women in underserved communities. RESULTS : The scoping review highlighted disparities in self-sampling intervention usage between low-and middle-income countries (LMICs) and high-income countries (HICs), underscoring the need for universal health coverage and the potential of self-sampling to bridge STI healthcare access gaps. The systematic review and meta-analysis confirmed the diagnostic accuracy of self-collected specimens, supporting the scalability and effectiveness of self-sampling interventions in improving STI detection and reducing transmission. NGT sessions identified barriers to STI healthcare access, such as clinic distance, stigma, and limited STI knowledge. Key attributes for self-sampling included convenient access to self-collection kits, STI education, and youth-friendly healthcare environments. The DCE highlighted young women's preferences for self-sampling, emphasising enhanced access to self-collection kits, comprehensive STI education, confidential results communication, autonomy in self-collection methods, and youth-friendly healthcare environments. CONCLUSIONS : This pioneering study underscores the importance of user-centred, accessible, and inclusive STI healthcare services tailored to young women's needs. It addresses barriers to STI healthcare through the identified attributes and highlights young women's preferences, highlighting the significance of involving end-users in designing and implementing healthcare interventions. This research paves the way for more tailored, effective, and equitable healthcare interventions, contributing to improved sexual and reproductive health outcomes. It also contributes to advancing Sustainable Development Goals (SDG) 3 on health and well-being; SDG 5 on gender equity and empowerment of women and girls; SDG 10 for human rights to inequalities for all people, including underserved communities; and SDG 17 on collaborating with various stakeholders to achieve a common goal for improving STI healthcare management services.