Feasibility and acceptability of home-based self-collection of multiple vaginal swabs in a general population survey in Britain′s fourth National Survey of Sexual Attitudes and Lifestyles-4 (Natsal-4)

Background: Despite greater sensitivity of vaginal swabs compared to urine for detection of STIs and high acceptability in clinical settings, acceptability and feasibility of home-based self-collected vaginal swabs for research are less certain. We undertook development work to test these attributes for self-collected vaginal swabs for Natsal-4, a probability sample, interviewer-administered, survey of the ritish population aged 16-59 years. Methods: We conducted two pilot studies in 2021-22. After completing an interview, all participants identifying as cisgender women were invited to provide three self-collected vaginal swabs, with procedures for providing samples during or afte rface-to-face interviews or after remote interviews. Samples were posted to the laboratory. Consent was provided with the understanding of non-return of results. Participants declining vaginal swabs were invited to provide urine. Interviewers were not clinically trained. Qualitative follow-up interviews were conducted with participants and interviewers provided feedback. Results: Of the 153 cisgender women interviewed, 77 (50%) agreed to provide a vaginal swab, and 22 preferred to provide urine, resulting in an overall biosample consent rate of 65%. Of these, 60 swabs and 18 urine samples were received (Figure), resulting in an overall response of 51% (39% for vaginal swabs). Of the 77 who consented to provide swabs, 43 (56%) were during face-to-face interviews, of which 95% were received, compared to 13 (17%) agreeing to collection after face-to-face with 54% received, and 21 (27%) choosing remote interviews with 57% received. Fourteen participants (10 provided swabs) gave follow-up interviews and seven interviewers provided feedback. Participants conveyed their motivation to support research by giving samples. Interviewers were surprised at participants’ willingness to provide swabs. Reasons for not providing a swab included the belief that it was uncomfortable, too intimate or not relev