P386 Acceptability of self-collected samples for diagnosis of sexually transmitted infections among transgender women in São Paulo cohort study

Background As a component of an ongoing cohort study measuring the incidence of HIV among transgender women in Sao Paulo, Brazil, this study assessed the acceptability of introducing self-collected sampling for the etiological diagnosis of sexually transmitted infections (STIs). Etiological diagnosis would require sampling potential anatomical infection sites, including oropharyngeal, anorectal, urethral, neovaginal and urine samples. Methods A convenience sample of 23 participants during a scheduled study visit were recruited to this study between October and November 2018. All participants reported being assigned male sex at birth and identified with a feminine gender identity at time of study, with one participant having gender-affirmative surgery to remove their male genitalia. Data collection was through a short investigator-led questionnaire in Portuguese, and included presentation of investigator-designed, gender-neutral instructional diagrams for self-sampling. Three supplemental focus group discussions guided by semi-structured script were conducted in Portuguese between September and October 2019. Results All participants (100%; n=23) indicated willingness to provide samples for STI screening during a future study visit. Participant preference was for self-collection of urine samples (82.6%; n=19), urethral swabs (81.8%; n=18), and anorectal swabs (77.3%; n=17). A lower preference for self-collection of oropharyngeal swabs (47.8%; n=11) was observed. Most respondents (78.3%; n=18) indicated that they would not prefer sampling to be collected by a health professional, mainly due to ‘more privacy’ (72.2%; n=13). All participants (n=20; 3 missing) indicated that they would feel comfortable to provide a self-collected sample based on instructional diagrams shown. Conclusion This study suggested acceptability among transgender women of introducing self-collected sampling for etiological diagnosis of STIs from potential infection sites. Novel gender-neutral instructional diagrams received positive responses of understanding to enable self-collected samples, with further development and testing warranted. Uptake and usability will be explored in TransOdara, a cross-sectional STI prevalence study of transgender women in Brazil.