Biomedical technologies in context: Acceptability of a screening tool for sexually transmitted infections and bacterial vaginosis in Zimbabwe and South Africa

Novel point-of-care tools tailored to contextual needs are critical for improving sexually transmitted infection (STI) management. The genital inflammation test (GIFT) is a point-of-care test under development to detect genital inflammation. A potential use of GIFT is as a screening tool to identify asymptomatic women who may have a sexually transmitted infection (STI) or bacterial vaginosis (BV), followed by confirmatory STI- testing if GIFT-positive. This study assessed the prospective acceptability of GIFT within national healthcare sectors in South Africa and Zimbabwe, where STI diagnostics are limited. In-depth interviews were conducted with women (n = 33), healthcare professionals (HCPs; n = 20) and decision-makers (n = 12) alongside seven focus group discussions (FGDs) with women (n = 16) and HCPs (n = 35). Thematic analysis was guided by Sekhon's framework of acceptability. Women showed a strong desire for devices to support sexual health and viewed diagnostic testing positively. However, acceptability declined when GIFT was explained as a screening tool requiring follow-up diagnostics, due to cost and limited availability of STI tests. HCPs and decision-makers similarly questioned its utility in constrained settings, despite recognising its potential as a potential catalyst for cheaper, point-of-care, infrastructure-light STI diagnostics. GIFT's acceptability is shaped by health system limitations, underscoring the need for clear communication, affordable diagnostics, and co-designed care pathways.