Acceptability and feasibility of one-stop home-based genital self-sampling for Female Genital Schistosomiasis, Human Papilloma Virus and self- testing for Trichomonas and HIV: The Zipime Weka Schista Study in Zambia

Background Female genital schistosomiasis (FGS) is a neglected gynaecological disease that affects over 50 million girls and women in sub-Saharan Africa. It is caused by the waterborne parasite Schistosoma (S.) haematobium and has been associated with HIV infection, with human papillomavirus (HPV) and cervical precancer. FGS alters the normal sexual and reproductive health of girls and women. Diagnosis is bottlenecked, but previous studies have shown acceptability of genital self-sampling at home for individual diagnosis of FGS, HPV and selected STIs. Here, we aim to determine the acceptability and feasibility of home-based multi-pathogen self-sampling and testing. Methods The Zipime Weka Schista study is an ongoing longitudinal cohort integrating a one-stop home-based genital self-sampling for S. haematobium and HPV DNA detection with self-testing for HIV and Trichomonas vaginalis (Tv ) in three communities in Zambia. Sexually active women aged 15-50 years were randomly selected by community health workers and visited at home where they were invited to provide two cervicovaginal self-swabs and a urine sample, and to conduct self-tests for HIV and Tv . During the home visit, community health workers collected information on the acceptability and feasibility of the multi-pathogen genital self-sampling approach using a questionnaire. A follow-up visit was done in clinic. Results A total of 2,701 women were initially approached by community health workers and 2,532 were enrolled between January 2022 – March 2023. A total of 100% (2,532) women provided self-swabs, and 94.3% (2,389) and 55.4% (1,404) undertook Tv and HIV self-tests, respectively. Of these, 67% (1,694) were followed up in clinic. There was high acceptability 76.4% (1,934) on the procedures for home multi-genital self-sampling. Many participants 87.2% (2,208) preferred to be seen at home than in clinic. Some reasons stated were convenience 62.6% (1,585); privacy 47.9% (1,215); going to the clinic was not convenient 10.4% (264); lack of transport to go to the clinic 8.2% (208); unavailability due to work 4.6% (118) and availability of childcare 2.7% (69). Conclusion Home-based multi-pathogen self-sampling and testing is highly acceptable and feasible in three communities in Zambia. This has potential to increase access to diagnosis, treatment and care for different infections co-existing in women.