Integrating STI testing and treatment with routine HIV care in Gaborone, Botswana.

Background Sexually transmitted infection (STI) testing is not routinely offered in many countries and management is symptoms-based. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are associated with increased risk of HIV transmission. We assess the feasibility and acceptability of integrating CT/NG testing into routine HIV care in Botswana, as well as the prevalence and correlates of CT/NG infections. Method A prospective study was conducted at an HIV clinic in Gaborone between February and October 2019. Eligibility criteria included: ≥ 18 years, HIV-infected, and not treated for CT/NG in past month. Participants self-collected samples and responded to a questionnaire on sociodemographic and health characteristics. Samples were processed using the GeneXpert®. Patients were offered same-day results in person or by telephone. Those who tested positive were treated. Results Of 806 patients informed of the study, 526 (65%) expressed interest and 451 (60%) were enrolled. The median age was 48 years, and 66% were women. All participants provided self-collected samples, were successfully tested, and received results. Almost all said self- collecting samples was easy. The prevalence of CT/NG was 5%. Most participants (73%) with a positive result were asymptomatic. Among infected, 20 (91%) received same-day results and all were treated. Younger age, female sex, and pain during sex were associated with having CT/NG. Conclusion Integrating STI testing into routine HIV care was feasible, self-collecting specimens was highly acceptable, but uptake of testing was low. Where blanket screening to the entire clinic population may not be feasible due to resource limitation; one strategy could be to prioritize sexually active patients, younger patients and women.