Client and Health Care Provider Perspectives on Point-of-Care Testing for Sexually Transmitted Infections in Community Pharmacies in Uganda

Introduction: The World Health Organization (WHO) recommends testing for sexually transmitted infections (STIs), but laboratory-based and rapid or point-of-care (POC) testing are often unavailable and unaffordable, especially in low-resource settings, leading to empiric (usually antibiotic) treatment. Community pharmacies (CPs) are often the first point of contact for persons with symptoms of STIs, where pharmacists dispense treatment without diagnostic testing or prescriptions. This study evaluated clients, providers, and policymakers' perspectives on POC testing for STIs in CPs for targeted treatment. Methods: We nested a qualitative study into a study of participants seeking both STI and non-STI treatments in CPs. They were tested for HIV, syphilis, trichomonas, chlamydia, and gonorrhea using both rapid POC tests and a central reference lab. A purposive sample of 50 participants from September 2020 to June 2022 consented to participate in in-depth and key informant interviews. Data were analyzed thematically using an inductive approach. Results: Clients (n=35), health care providers (n=9), and policy makers (n=6) highlighted the benefits of POC tests for HIV and STIs at CPs, including affordability, accessibility, and ensuring convenience. The impact of POC testing for STI diagnosis and treatment was promoting behavioral change, rapid results turnaround time, leading to faster treatment access compared to conventional laboratory methods, and supporting sustainable antimicrobial resistance (AMR) control. Barriers to POC testing included a lack of awareness among clients and health workers, inadequate privacy and space, long wait times, unclear self-sample collection instructions, stigma around HIV testing, and reluctance to test for STIs beyond HIV. To address these, participant recommendations included raising STI awareness, providing more explanation of test results, increasing test access, addressing stigma, provider training, and ensuring a sustainable supply chain for testing kits. Conclusions: POC testing for STIs and HIV in CP settings was found to be highly acceptable to both pharmacy clients and providers. Integrating POC testing in CPs could be beneficial for national STI management programs. If the existing barriers are addressed, POC tests could improve accessibility to STI diagnostics and facilitate better linkage to care.