“Provided power is there, it will be a good initiative”: healthcare provider perspectives on diagnostic screening for curable STIs during pregnancy in Botswana

Diagnostic screening for curable sexually transmitted infections (STIs) during antenatal care has the potential to improve health outcomes among women and infants in low- and middle-income countries (LMICs). To inform roll-out and scale up of antenatal STI screening in LMICs, it is important to understand the facilitators and barriers to implementation. Considering healthcare provider perspectives prior to roll-out is essential for ensuring the feasibility, acceptability, and effectiveness of screening programmes. We explored healthcare worker perspectives on syndromic management and diagnostic screening for Chlamydia (C.) trachomatis and Neisseria (N.) gonorrhoeae during pregnancy through in-depth interviews. Between April and October 2023, we conducted 15 in-depth interviews with healthcare workers providing antenatal/STI care in Gaborone, Botswana. Interviews were audio-recorded, transcribed, coded using NVivo and emergent themes were identified. All providers expressed support for the roll-out of diagnostic screening for C. trachomatis and N. gonorrhoeae during pregnancy (“ if there are new technologies , let’s move forward”). However, they identified several structural issues to be addressed within the existing healthcare system prior to implementation including electricity reliability (“ provided power is there it will be a good initiative ”), space constraints (“…the other challenge is space”) , supply stock-outs (“ the system , sometimes it collapses…the supplies run off” and “there are times when you don’t have even the treatment” ), staffing constraints (“I think we are so overwhelmed with a lot of work…” ), and lack of equipment maintenance (“…things they are put. Then after , they no longer work” ). In addition to ensuring sufficient infrastructure and resources, facilitators to implementation of antenatal STI screening included staff training, health education for patients and faster tests. While the majority of providers supported diagnostic STI screening during pregnancy to identify specific infections and avoid missed diagnoses, they also noted several barriers that need to be considered prior to roll-out.