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Self-Collection of Vaginal Swabs Among Adolescent Girls in a School-Setting in East Africa

Francis, Suzanna C. PhD, MPH*; Miiro, George MD, MSc; Nakuya, Kevin BA; Rutakumwa, Rwamahe MSc, PhD; Nakiyingi-Miiro, Jessica MSc, PhD; Nabaggala, Grace MSc; Musoke, Saidat BA; Namakula, Juliet BA; Tanton, Clare MSc, PhD*; Torondel, Belen MSc, PhD§; Ross, David A. MA, MSc, BMBCh, PhD; Weiss, Helen A. MSc, DPhil* On behalf of the MENISCUS project team

Sexually Transmitted Diseases: May 2019 - Volume 46 - Issue 5 - p 335–341
doi: 10.1097/OLQ.0000000000000990
Original Studies

Background Few studies have evaluated the acceptability of self-collected vaginal swabs among young women in sub-Saharan Africa, including in school settings. We evaluated the acceptability of 2 conditions for the self-collection of swabs in secondary schools in Entebbe, Uganda.

Methods Assenting girls with parental consent from 3 secondary schools were provided instructions for sampling, and randomly allocated to self-collection of vaginal swabs with or without nurse assistance to help with correct placement of the swab. Swabs were tested for bacterial vaginosis by Gram stain. Participants were followed up after 1 to 2 days and 1 to 2 weeks and invited for a qualitative interview.

Results Overall 96 girls were enrolled (median age, 16 years; interquartile range, 15–17 years). At the first follow-up visit, participants in both arms reported that instructions for sample collection were easy to understand, and they felt comfortable with self-collection. Girls in the nurse assistance arm reported feeling less relaxed (27% vs. 50%, P = 0.02) than those in the arm without nurse assistance, but more confident that they collected the sample correctly (96% vs. 83%, P = 0.04). About half (47%) of participants agreed that self-sampling was painful, but almost all (94%) would participate in a similar study again. Qualitative data showed that participants preferred self-collection without nurse assistance to preserve privacy. Bacterial vaginosis prevalence was 14% (95% confidence interval, 8–22).

Conclusions In this setting, self-collection of vaginal swabs in secondary schools was acceptable and feasible, and girls preferred self-collection without nurse assistance. Self-collection of swabs is an important tool for the detection, treatment and control of reproductive tract infections in girls and young women.

The self-collection of vaginal swabs for the testing of reproductive tract infections is acceptable and feasible in a school setting among adolescent girls in Uganda. This is an important tool for school-based health interventions in this population.

From the *MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom;

Uganda Virus Research Institute;

Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda;

§London School of Hygiene and Tropical Medicine, London, United Kingdom; and

Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland

Acknowledgements: The authors thank the participants without who this study would not have been possible. The authors also thank the study teams for their dedication and hard work. The authors would like to thank the MRC/UVRI & LSHTM Uganda Research Unit laboratory, data unit and administrative teams for their support of this study.

Funding: This work was funded by a research grant MC_PC_14098 from the UK Medical Research Council and the World Health Organisation (WCCPRD3992640 2016/599225). H.A.W., S.C.F., and B.T. were supported by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) (MR/K012126/1) under the MRC/DFID Concordat agreement and is also part of the EDCTP2 program supported by the European Union.

Deceased: George Miiro.

The members of the MENSICUS project team include: Helen Weiss, David Ross, George Miiro, Jessica Nakiyingi-Miiro, Suzanna C. Francis, Belen Torondel, Rwamahe Rutakumwa, Jeff Deckles, Saidat Namuli, Milly Naluggya, Rashid Muyingo, Philip Muzira, Habakkuk Ayebazibwe, Kevin Nakuya, Elizabeth Nakinobe, Wilber Ssembajjwe, Juliet Namakula, Christopher Lukooya, Yawe Douglas, Viola Mirembe, Racheal Wanyana, Lorna Gibson, Rebecca Hershow, Pontiano Kaleebu, and Edward Katongole Mbidde.

Correspondence: Suzanna C. Francis, PhD, MPH, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. E-mail:

Received for publication October 2, 2018, and accepted December 16, 2018.

© Copyright 2019 American Sexually Transmitted Diseases Association