113. Acceptability of and Preference for Self- and Clinician-Collected Swabs Among Gender-Diverse Adolescents and Young Adults

Transgender and gender-diverse (TGD) adolescents and young adults (AYA) experience disparities across healthcare, including sexual health. The aim of this study was to assess the acceptability of and preference for self- and clinician-collected as well as home- and clinic-based collection of pharyngeal, vaginal, and rectal swabs for testing for sexually transmitted infections (STI) among TGD AYA receiving primary and/or specialty care from a large Transgender Health Center. Individuals 14-24 years old were eligible to participate if they self-identified as TGD and had history of consensual sexual experience. Electronic questionnaires assessed demographics, gender identity, genital dysphoria, sexual history, experience with STI sample collection, and outcome variables. Outcome variables were acceptability of and preference for self- and clinician-collected pharyngeal, vaginal, and rectal swabs for STI testing as well as acceptability of and preference for self-collection of pharyngeal, vaginal, and rectal swabs at home and in clinic. Acceptability question responses used a 5-point Likert-like scale. Participants indicated if they preferred self- or clinician-collection and home or clinic-based swab collection. Analysis included descriptive statistics. Forty-two individuals completed the questionnaire. Participant’s average age was 19.5 years (range 14-24). Thirty-two (76%) participants were assigned-female-at-birth. Gender identity was reported as transmasculine by 71%, transfeminine by 19%, and non-binary/genderqueer by 5%. A majority (83%) of participants reported genital dysphoria. Fifty percent of participants reported no condom use. Most participants reported experience with self-collected (78%) and clinician-collected (62%) swabs. Among all participants, a majority reported pharyngeal swab self-collection (83%) and clinician-collection (98%) as acceptable/highly acceptable. A majority (76%) preferred clinician-collection of pharyngeal swabs. A majority reported collection at home (76%) and clinic (95%) acceptable/highly acceptable. A majority (79%) preferred clinic-based collection. Among participants assigned-female-at-birth, a majority reported vaginal swab self-collection (97%) as acceptable/highly acceptable. Less than half (48%) reported vaginal swab clinician-collection as acceptable/highly acceptable. A majority (84%) preferred self-collection of vaginal swabs. A majority reported vaginal swab collection at home (81%) and clinic (87%) acceptable/highly acceptable. A majority (61%) preferred clinic-based collection. Among all participants, a majority reported rectal swab self-collection (83%) as acceptable/highly acceptable. About half (57%) reported rectal swab clinician-collection as acceptable/highly acceptable. A majority (76%) preferred self-collection of rectal swabs. A majority reported collection at home (79%) and clinic (83%) acceptable/highly acceptable. A majority (62%) preferred clinic-based collection. In this TGD AYA population, genital dysphoria was common. Self-collection of vaginal and rectal swabs was acceptable to and preferred by a majority of TGD AYA participants suggesting that clinicians should offer multiple sample collection methods. Over one-third of participants preferred home collection of vaginal and rectal samples, suggesting home-collection of STI samples may be feasible among TGD AYA.