Service delivery of at-home STI testing using self-collected samples: a qualitative investigation of values and preferences among adults in Rakai, Uganda

Background Studies have shown that clients accept the self-collection of samples for sexually transmitted infection testing (SCS/STI testing), and at-home service delivery is a promising approach to expand diagnosis. However, few studies have examined client values surrounding service delivery in low-resource settings. This formative research study explores clients' service delivery values and preferences for at-home SCS/STI testing in rural Uganda. Methods We conducted semi-structured interviews with 36 adults - 15 males and 21 females - who self-collected a sample for STI testing in Rakai, Uganda, as part of the Rakai Community Cohort Study. After self-collection, participants were asked for their preferences on various at-home service delivery components, including: (1) requesting/receiving testing materials, (2) sending samples to the laboratory, (3) receiving results, and (4) receiving treatment; as well as various service delivery models. We also conducted interviews with nine key informants to contextualize results. Using the framework method, we identified key preferences across all participants, and stratified by gender. Results Participants most valued an at-home SCS/STI testing program that offered timely service, as well as health professionals' expertise. Clients also valued privacy/confidentiality; certainty that processes were completed correctly; access to services/resources; and ownership/responsibility for their own health. Although these values were expressed by both genders, access, privacy/confidentiality and ownership/responsibility were more prominent among females. Conclusions Our findings suggest a potential role for at-home SCS/STI testing in this population, as long as key client values are addressed. Program implementers will need to consider how to balance convenience for clients with professional support.