{"paper_id":"0ab77572-84ab-4340-a615-9801172db852","body_text":"Accuracy of self-collected versus healthcare worker collected specimens for diagnosing sexually transmitted infections: an updated systematic review and meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Article Accuracy of self-collected versus healthcare worker collected specimens for diagnosing sexually transmitted infections: an updated systematic review and meta-analysis Ziningi Jaya, Witness Mapanga, Thobeka Dlangalala, Nokukhanya Thembane, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3909356/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 May, 2024 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract The use of self-collected specimens as an alternative to healthcare worker-collected specimens for diagnostic testing has gained increasing attention in recent years. This systematic review aimed to assess the diagnostic accuracy of self-collected specimens compared to healthcare worker-collected specimens across different sexually transmitted infections (STIs) including chlamydia, human papillomavirus (HPV), Mycoplasma genitalium (MG), gonorrhoea, syphilis and trichomoniasis in females. A rigorous process was followed to screen for studies in various electronic databases. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. There were no studies on syphilis that met the criteria for inclusion in the review. A total of six studies for chlamydia, five studies for HPV, four studies for MG, and seven studies for gonorrhoea and trichomoniasis were included in the review. However, not all studies were included in the sub-group meta-analysis. The analysis revealed that self-collected specimens demonstrated comparable diagnostic accuracy to healthcare worker-collected specimens across most STIs. This indicates that the diagnostic accuracy of self-collected specimens can provide accurate results and enhance access to diagnostic testing, potentially improving healthcare service delivery. Future research should further explore the diagnostic accuracy of self-collected specimens in larger and more diverse populations. self-collect sexually transmitted infections diagnostic specimens females women Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Introduction Sexually transmitted infections (STIs) are a major global health concern that causes symptomatic and asymptomatic infections ( 1 , 2 ). Most STIs caused by bacteria and parasites are curable if diagnosed and treated accordingly but most viral STIs are incurable ( 3 , 4 ). The largest portion of STIs occurs in females across the globe ( 2 , 5 ). In females, the consequence of undiagnosed and untreated STIs can result in reproductive health complications that include infertility, stillbirths, cancer development and increased susceptibility to HIV ( 1 , 2 , 4 , 6 , 7 ). Considering this, our study focused on STIs in females. Governments across the globe, particularly in low-and-middle-income countries (LMICs) continue to use syndromic management of STIs due to a scarcity of resources and restricted access to diagnostic laboratories ( 8 , 9 ). This approach relies on reported signs and symptoms, and physical examinations for diagnosis and then treatment is issued for the most common STIs ( 8 , 10 ). In light of this, it deters infected individuals who fear invasive genital examinations and stigmatization associated with STIs ( 11 ). Additionally, this approach cannot address asymptomatic infections because these individuals may not seek care ( 8 , 12 ). As such, asymptomatic individuals continue to spread infection and become susceptible to long term STI complications. Syndromic management often promotes over-diagnosing and over-treating because treatment is issued often targeting the most common STI causative pathogens instead of a specific pathogen ( 13 , 14 ). As such Murewanhena et al. ( 14 ) suggest a shift from syndromic management of STIs to a more pathogen specific diagnosis and treatment of STIs. The development of innovative alternative interventions, such as self-sampling, is key to improving STI healthcare service provision ( 15 , 16 , 17 ). Self-sampling enables individuals to self-collect specimens for STI diagnosis either at home or healthcare facilities or in places where they are comfortable ( 18 ). This intervention can be used to screen for asymptomatic infections ( 11 ), and screen infections in remote areas where access to quality healthcare is limited ( 19 , 20 ). Based on this, self-sampling can address the challenges linked to the syndromic management of STIs ( 19 , 21 ). However, self-sampling may jeopardise specimen quality since the collection is performed by inexperienced individuals. Since the potential of self-sampling interventions for STI diagnosis is evident, it is imperative to determine their diagnostic accuracy and reliability. A scoping review conducted by Jaya et al ( 22 ) in 2021 presented evidence that supports self-sampling interventions as appropriate alternatives to physician collected specimens for STI diagnosis. A meta-analysis conducted in 2005 proved that self-collected swabs were suitable alternatives to clinician-collected specimens for the diagnosis of human papillomavirus (HPV) ( 23 ). A systematic review and meta-analysis conducted in 2015 on Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) also reported that self-collected specimens were reliable for diagnostic testing ( 15 ). Considering the potential impact of the self-sampling intervention on sexual and reproductive healthcare there is a need for an updated systematic review and meta-analysis sexual and reproductive healthcare. This is to foster improvements in clinical decision-making pertaining to sexual and reproductive healthcare provision. As such, the current study is an updated systematic review and meta-analysis on the accuracy of self-collected specimens compared to healthcare worker-collected specimens for STI diagnosis. This study will evaluate the diagnostic accuracy of self-sampling for STI diagnosis in studies conducted from 2015 onwards because a systematic review of a similar nature included studies up to 2015. The overarching aim of an updated systematic review is to ensure that the best evidence to inform clinical decision making and healthcare policy development for STI healthcare is provided. Methods Protocol and registration The protocol for this study was submitted to the International Registration of Systematic Reviews (PROSPERO), with the registration number CRD42022341462. This study was guided by the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) ( 24 ). Eligibility criteria The Population, Intervention, Comparison, and Outcome (PICO) framework for determining the research question eligibility was followed. Studies were included if they: a) assessed the accuracy of self-collected specimens against healthcare worker-collected specimens for STI diagnosis in women were included, b) studies that used healthcare worker collected specimens as the reference or gold standard, c) the study population comprised of specimens that had been tested for STIs including HPV, NG, CT, Treponema pallidum (syphilis), Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG), d) examined self-collected versus clinician-collected samples using different diagnostic assays including nucleic-acid-based assays, and manual methods that included wet mount, culture, and gram stain peer-reviewed studies published in 2015 and onwards to diagnose STIs. Data on investigations conducted on females will be extracted from studies that include people of another gender. There were no language restrictions applied and studies with different study designs were included. Studies were excluded if: a) the time of self-sampling and healthcare worker specimen collection exceeded three weeks due to the window period for seroconversion, b) presented information on combined specimen results, c) self-sampling was not conducted in females, d) self-sampling and healthcare worker collected specimen was collected from different individuals. Index test The diagnostic accuracy of self-collected specimens to diagnose STIs was evaluated against healthcare worker specimens. Self-collected specimens for STI diagnosis included vaginal swabs, urine, cervical swabs and tampons. The sensitivity and specificity of each diagnostic assay for each STI were evaluated. Reference standard Healthcare worker-collected specimens for the diagnosis of STIs were used as the gold reference standard in this study. Search strategy A systematic search of data was conducted in Cochrane, Medline, Scopus, Web of Science, PubMed, and Wed of Science electronic databases (see Table 1 ). The search was limited to studies from 2015 onwards. The Principal Investigator (PI) developed the search strategy with an experienced librarian at the University of Pretoria. Medical Subject Headings (MeSH) terms were used to define our searches with Boolean operators (AND/OR) between search terms. The search terms used included but were not limited to 1) “Self-sampling” or “self-collected” or ‘self-administered” or “self-obtained” 2) “sexually transmitted infections” 3) “diagnostic specimens” or “diagnostic samples” 4) “women” or “females”. A hand search for grey literature was also conducted on the WHO website, the Department of Health South Africa (DoH SA), and the Open Grey website. Table 1 Database search Date Database Keywords Number of results retrieved 14 July 2021 Scopus ( TITLE-ABS-KEY ( sampling OR sample OR \"self sampling\" OR \"self sample\" OR \"sti testing\" OR \"sti diagnosis\" OR \"sexually transmitted infections test*\" OR \"self-collect*\" OR \"sexually transmitted disease testing*\" ) AND TITLE-ABS-KEY ( \"Specimen Handling\" ) AND TITLEABS-KEY ( \"Sexually Transmitted Disease*\" OR \"sexually transmitted infection*\" ) AND TITLE-ABS-KEY ( wom*n OR female* OR girl* ) AND NOT TITLE-ABS-KEY ( aids OR \"HIV Infections\" OR hiv OR \"human immunodeficiency virus\" OR \"acquired immunodeficiency syndrome\" ) ) 117 15 July 2021 Cochrane (sampling OR sample OR \"self sampling\" OR \"self sample\" OR \"sti testing\" OR \"sti diagnosis\" OR \"sexually transmitted infections test*\" OR \"selfcollect*\" OR \"sexually transmitted disease testing*\"):ti,ab,kw (Word variations have been searched) 26 19 July 2021 PubMed (((sampling[tw] OR sample[tw] OR \"self sampling\"[tw] OR \"self sample\"[tw] OR \"sti testing\"[tw] OR \"sti diagnosis\"[tw] OR \"sexually transmitted infections test*\"[tw] OR \"self-collect*\"[tw] OR \"sexually transmitted disease testing*\"[tw] AND (female[Filter])) AND (\"Specimen Handling/methods\"[Mesh] OR \"Specimen Handling\"[tw] AND (female[Filter]))) AND (\"Sexually Transmitted Diseases, Bacterial\"[Mesh] OR \"Sexually Transmitted Diseases, Viral\"[Mesh] OR \"sexually transmitted infection*\"[tw] OR \"sexually transmitted disease*\"[tw])) NOT (\"HIV Infections\"[Mesh] OR \"HIV Infections\"[tw]) 213 19 July 2021 Wb of Science ((((ALL=(sampling OR sample OR \"self sampling\" OR \"self sample\" OR \"sti testing\" OR \"sti diagnosis\" OR \"sexually transmitted infections test*\" OR \"self-collect*\" OR \"sexually transmitted disease testing*\")) AND ALL=( \"Sexually Transmitted Disease*\" OR \"sexually transmitted infection*\" OR STI OR STD)) AND ALL=(wom*n OR female* OR girl*)) AND ALL=(\"Specimen Handling\" or \"Specimen Collection\" OR Specimen)) NOT ALL=(aids OR \"HIV Infections\" OR hiv OR \"human immunodeficiency virus\" OR \"acquired immunodeficiency syndrome\") 311 21 July 2022 MEDLINE (EBSCO) (((ALL=(sampl* OR \"self sampl*\" OR \"sti test*\" OR \"sti diagnosis\" OR \"sexually transmitted infections test*\" OR \"self-collect*\" OR \"sexually transmitted disease test*\"))) AND ALL=( ) NOT ALL=(\") 140 26 Aug 2022 PubMed (((sampling[tw] OR sample[tw] OR \"self sampling\"[tw] OR \"self sample\"[tw] OR \"sti testing\"[tw] OR \"sti diagnosis\"[tw] OR \"sexually transmitted infections test*\"[tw] OR \"self-collect*\"[tw] OR \"sexually transmitted disease testing*\"[tw]) AND (\"Specimen Handling/methods\"[Mesh] OR \"Specimen Handling\"[tw])) AND (\"Sexually Transmitted Diseases, Bacterial\"[Mesh] OR \"Sexually Transmitted Diseases, Viral\"[Mesh] OR \"sexually transmitted infection*\"[tw] OR \"sexually transmitted disease*\"[tw])) NOT (\"HIV Infections\"[Mesh] OR \"HIV Infections\"[tw]) Filters: Female, from 2021–2022 8 26 August 2022 Web of Science ((((ALL=(sampling OR sample OR \"self sampling\" OR \"self sample\" OR \"sti testing\" OR \"sti diagnosis\" OR \"sexually transmitted infections test*\" OR \"self-collect*\" OR \"sexually transmitted disease testing*\")) AND ALL=( \"Sexually Transmitted Disease*\" OR \"sexually transmitted infection*\" OR STI OR STD)) AND ALL=(wom*n OR female* OR girl*)) AND ALL=(\"Specimen Handling\" or \"Specimen Collection\" OR Specimen)) NOT ALL=(aids OR \"HIV Infections\" OR hiv OR \"human immunodeficiency virus\" OR \"acquired immunodeficiency syndrome\") 28 26 August 2022 MEDLINE (EBSCO) ( sampling OR sample OR \"self sampling\" OR \"self sample\" OR \"sti testing\" OR \"sti diagnosis\" OR \"sexually transmitted infections test*\" OR \"self-collect*\" OR \"sexually transmitted disease testing*\" ) AND ( (MH \"Sexually Transmitted Diseases+\") OR \"Sexually Transmitted Disease*\" OR \"sexually transmitted infection*\" OR STI OR STD ) AND ( \"Specimen Handling\" OR (MH \"Specimen Handling+\") ) NOT ( (MH \"HIV\") OR (MH \"Acquired Immunodeficiency Syndrome\") OR aids OR \"HIV Infections\" OR hiv OR \"human immunodeficiency virus\" OR \"acquired immunodeficiency syndrome\" ) 12 26 August 2022 Scopus ( TITLE-ABS-KEY ( sampling OR sample OR \"self sampling\" OR \"self sample\" OR \"sti testing\" OR \"sti diagnosis\" OR \"sexually transmitted infections test*\" OR \"self-collect*\" OR \"sexually transmitted disease testing*\" ) AND TITLE-ABS-KEY ( \"Specimen Handling\" ) AND TITLEABS-KEY ( \"Sexually Transmitted Disease*\" OR \"sexually transmitted infection*\" ) AND TITLE-ABS-KEY ( wom*n OR female* OR girl* ) AND NOT TITLE-ABS-KEY ( aids OR \"HIV Infections\" OR hiv OR \"human immunodeficiency virus\" OR \"acquired immunodeficiency syndrome\" ) ) 7 26 August 2022 Cochrane (sampling OR sample OR \"self sampling\" OR \"self sample\" OR \"sti testing\" OR \"sti diagnosis\" OR \"sexually transmitted infections test*\" OR \"selfcollect*\" OR \"sexually transmitted disease testing*\"):ti,ab,kw (Word variations have been searched) 0 Study selection Screening of studies suitable for inclusion in the systematic review and meta-analysis was conducted on the studies between 2015–2022. Since this systematic review stems from the findings of a scoping review which was conducted in 2021. Studies which had been screened for the scoping review from 2015–2021 were re-screened using eligibility criteria for the systematic review. To ensure the inclusion of studies conducted in 2022, the assisting librarian conducted a new search for studies that were published in 2022. An EndNote library was then created for all studies that were eligible for full-text screening. Thereafter, ZNJ and TD performed full-text screening of all studies that fulfilled the eligibility criteria of the systematic review and meta-analysis. NT resolved discrepancies that arose during full-text screening by ZNJ and TD. Thereafter, ZNJ and NT extracted data from studies found eligible for inclusion at the full-text screening stage. Thereafter, any disagreements were resolved by discussion until an agreement was reached. Study selection for the systematic review was guided by the PRISMA flowchart. Data extraction ZNJ and NT independently extracted data from eligible studies using a data extraction tool that was designed to extract data from the included primary studies. The tool was piloted using 10% of the included studies and amended accordingly before final use. The extracted data was divided into two separate sections namely a section for basic qualitative information and another section for the quantitative outcomes of interest. Basic information extracted included author name(s) and year of publication, study title, study aims, study population, study design, sample size, eligibility criteria, reference standard specimen, type of self-collected specimen, type of laboratory assay, main findings, and conclusions. Data extracted for the section on the outcome of primary studies true positive, true negative, false positive, false negative, sensitivity and specificity, positive predictive value, negative predictive value, and evidence of agreement or concordance between self-collected and healthcare worker collected specimens. In some instances, the true negative, true positive false positive and false negative results were not available, and the relevant data was requested from the authors. A 2x2 table was produced based on the collected data. Any discrepancies that arose between the reviewers were discussed until a unanimous resolution was reached. Assessment of methodological quality The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for primary diagnostic accuracy studies, was utilised to assess the quality of all the included studies ( 25 ). This tool consists of four main domains that include patient selection, index test, reference standard, and flow and timing ( 25 ), which were adapted to the current study accordingly. To determine the risk of bias, signalling questions answered as “yes” “no” or “unclear”, were used in each phase ( 25 ). Statistical analysis and data synthesis For included studies in which sensitivity and specificity had been assessed and reported a meta-analysis of diagnostic accuracy was performed. The Review Manager (RevMan) software was used to conduct statistical analysis. The RevMan software was also used to calculate the pooled sensitivity, specificity, and diagnostic odds ratio with a 95% confidence interval. Cochran’s Q statistics were utilised to determine heterogeneity among the included primary studies. Statistical significance in all the analyses was calculated using the p -value where a p-value of < 0.05 indicated statistical significance. Results Study selection and characteristics of included studies Sixteen studies conducted in 2015, which were retrieved during a database search for the scoping review underwent title screening using the relevant eligibility criteria for the systematic review. For the new database search conducted by the librarian to ensure the inclusion of studies in Aug 2022, forty-eight search results were retrieved. Nine were duplicates, which left only thirty-nine eligible for title screening. The abstract screening was then conducted on fifty-five studies (thirty-nine plus sixteen studies). Post abstract screening, thirty-seven studies were excluded and only eighteen studies were eligible for data extraction. Reasons for exclusion were studies presenting data on pooled specimens, studies not presenting data on self-collected and healthcare worker collected specimens, and studies not about self-sampling STIs. Post full text screening of the studies only fourteen were eligible for inclusion in the systematic review. Four studies were excluded for being conducted before 2015, studies not about self-sampling, not about STIs, and a study presenting data on pooled specimens. Ultimately, data extraction was conducted on a total of fourteen studies (see Fig. 1 below). There was moderate agreement between the reviewers at full-text screening ( kappa = 0.5 ). Characteristics of included studies The characteristics of included studies are all depicted in Table 2 . Fourteen studies were included in the systematic review but not all of them were included in the meta-analysis. A large portion of the studies, five studies, were from the United States of America (USA) ( 26 , 27 , 28 , 29 , 30 ), one study in Canada ( 31 ), one in Haiti ( 32 ), one in France ( 33 ), one study in Saudi Arabia ( 34 ), one in India ( 35 ), one in the Republic of Korea ( 36 ), one study in Kenya ( 37 ), one in Chad ( 19 ), one study in Ghana ( 38 ). See Table 3 for quantitative characteristics of included studies. It is important to note that some of the sensitivity and specificity measurements were obtained from the articles as calculated by the authors. However, where the measurements were not available, the researchers calculated using data that was already available on the manuscripts and original data obtained from authors of some of the included studies. Furthermore, for studies where this information was not available at all, it was not reported. Table 2 Characteristics of included studies DISEASE SPECIMEN AND TESTING Author, year published Country of study Study design Study population (sex) and samples size Mode of instruction for self-collection Location of self-collection Specimen (healthcare worker collected/self-collected Diagnostic platform Automated (run on instrument) / manual (manual method used) Assay type CT Arias et al 2016 ( 31 ) Canada Cross sectional Female − 189 Demonstration of collection method and self-collection had collection instructions Study clinic Vaginal swab/ vaginal swab Automated NAAT Aptima Combo 2 Camus et al 2021 ( 33 ) France Cross sectional Female = 1028 Instructions provided. Study clinic Vaginal/cervical classical sampling/ vaginal swab Automated COBAS – Roche Diagnostics Kits De Marais et al 2018 ( 27 ) USA Clinical trial Female = 193 Participants were instructed by a study nurse Home and clinic Cervical swab/ cervicovaginal swab Automated Aptima Combo2 Lockhart et al 2018 ( 37 ) Kenya Cross-sectional Female = 350 Participants were instructed verbally Study clinic Cervical swab/ cervicovaginal swab Automated Aptima combo assay Nodjikouambaye et al 2019 ( 19 ) Chad Cross-sectional Female = 271 Training on specimen collection. Study clinic Endocervical swab/ veil sample Automated Multiplex real-time PCR - Allplex STI Essential Assay Van Der Pol et al 2019 ( 30 ) USA Cross sectional Female = 3860 Not indicated Not indicated Vaginal swab/ vaginal swab, urine Automated NAAT - COBAS NG/CT test - the BD ProbeTec CT Qx and GC Qx amplified DNA assay; Aptima Combo 2 CT/NG; and the Abbott m2000 RealTime CT/NG assay. HPV Boggan et al 2015 ( 32 ) Haiti Cohort Female = 1836 Orientation by a study nurse. Study clinic Cervical swab/ vaginal swab Automated Hybrid Capture 2 High-Risk HPV DNA Test De Marais et al 2018 ( 27 ) USA Clinical trial Female = 193 Participants were instructed by a study nurse Home and clinic Cervical swab/ cervicovaginal swab Automated Aptima HPV assay Kim et al 2020 ( 36 ) Korea Cross sectional Female = 151 Digital and written instructions provided Study clinic Cervical swab/ vaginal swab Automated multiplex real-time PCR Anyplex II HPV28 Detection assay McLarty et al 2019 ( 28 ) USA Cross sectional Female = 174 Individual instructions were provided. Home and study clinic Cervical swab/ tampon, vaginal swab Automated Roche Cobas HPV method Obiri-Yeboah et al., 2017 ( 38 ) Ghana Cross sectional Female = 333 Instructed on how to obtain a specimen Study clinic Cervical swab/ vaginal swab Automated careHPV assay MG Camus et al 2021 ( 33 ) France Cross sectional Female = 1028 Instructions provided. Study clinic Vaginal/cervical classical sampling/ vaginal swab Automated TIB MOLBIOL LightMix – PCR Roche Diagnostics De Marais et al 2018 ( 27 ) USA Clinical trial Female = 193 Participants were instructed by a study nurse Home and clinic Cervical swab/ cervicovaginal swab Automated Aptima analyte-specific reagent-based assay Lockhart et al 2018 ( 37 ) Kenya Cross-sectional Female = 350 Participants were instructed verbally Study clinic Cervical swab/ cervicovaginal swab Automated Aptima combo assay Nodjikouambaye et al 2019 ( 19 ) Chad Cross-sectional Female = 271 Training on specimen collection. Study clinic Endocervical swab/ veil sample Automated Multiplex real-time PCR - Allplex STI Essential Assay NG Arias et al 2016 ( 31 ) Canada Cross sectional Female = 189 Demonstration of collection method and self-collection had collection instructions Study clinic Vaginal swab/ vaginal swab Automated NAAT Aptima Combo 2 Barbee et al 2021 ( 26 ) USA Cross-sectional Female = 89 Not indicated Study clinic Endocervical swab/ vaginal swab Manual and automated Culture and NAAT Aptima Combo 2 Camus et al 2021 ( 33 ) France Cross sectional Female = 1028 Instructions provided. Study clinic Vaginal/cervical classical sampling/ vaginal swab Automated COBAS – Roche Diagnostics Kits De Marais et al 2018 ( 27 ) USA Clinical trial Female = 193 Participants were instructed by a study nurse Home and clinic Cervical swab/ cervicovaginal swab Automated Aptima Combo2 Lockhart et al 2018 ( 37 ) Kenya Cross-sectional Female = 350 Participants were instructed verbally Study clinic Cervical swab/ cervicovaginal swab Automated Aptima combo assay Nodjikouambaye et al 2019 ( 19 ) Chad Cross-sectional Female = 271 Training on specimen collection. Study clinic Endocervical swab/ veil sample Automated Multiplex real-time PCR - Allplex STI Essential Assay Van Der Pol et al 2019 ( 30 ) USA Cross sectional Female = 3860 Not indicated Not indicated Vaginal swab/ vaginal swab, urine Automated NAAT - COBAS NG/CT test - the BD ProbeTec CT Qx and GC Qx amplified DNA assay; Aptima Combo 2 CT/NG; and the Abbott m2000 Real-Time CT/NG assay. TV Camus et al 2021 ( 33 ) France Cross sectional Female = 1028 Instructions provided. Study clinic Vaginal and cervical swabs/ vaginal swab Automated TIB MOLBIOL LightMix – PCR Roche Diagnostics De Marais et al 2018 ( 27 ) USA Clinical trial Female = 193 Participants were instructed by a study nurse Home and clinic Cervical swab/ cervicovaginal swab Automated Aptima TV assay Hawash et al 2021 ( 34 ) Saudi Arabia Cross sectional Female = 174 Instructions were provided and sample collection was done in the presence of medical personnel. Study clinic Vaginal swab/ vaginal swab Manual, and automated OSOM TV rapid test, wet prep, TV DNA PCR Khan et al 2019 ( 35 ) India Cross-sectional Female = 550 Participants were given instructions Study clinic Vaginal swab/ vaginal swab Manual Trichomonas culture Lockhart et al 2018 ( 37 ) Kenya Cross-sectional Female = 350 Participants were instructed verbally Study clinic Cervical swab/ cervicovaginal swab Automated Aptima combo assay Nodjikouambaye et al 2019 ( 19 ) Chad Cross-sectional Female = 271 Training on specimen collection. Study clinic Endocervical swab/ veil sample Automated Multiplex real-time PCR - Allplex STI Essential Assay Schwebke et al., 2018 ( 29 ) USA Cross sectional Female = 1867 Not indicated Study clinic Cervical swab/ vaginal swab Manual, and automated In Pouch TV broth culture and Aptima NAAT for TV CT = Chlamydia trachomatis; NG = Neisseria gonorrhoea; TV = Trichomonas vaginalis; HPV = Human papillomavirus; DNA = Deoxyribonucleic acid; PCR = Polymerase Chain Reaction; Veil sample = self-collection device for cervicovaginal fluid collection. Table 3 Quantitative characteristics of included studies DISEASE HEALTHCARE WORKER VS SELF-COLLECTED SELF-COLLECTED ONLY HEALTHCARE WORKER COLLECTED ONLY Author, year published TP FP TN FN PPV (%) NPV (%) Cohen’s kappa/ concordance (%) Sensitivity (%) Specificity (%) Sensitivity (%) Specificity (%) Sensitivity (%) Specificity (%) Chlamydia trachomatis Arias et al 2016 ( 31 ) 5 10 159 6 33 96 98.4 50 94.4 - - - - Camus et al 2021 ( 33 ) 33 1 994 0 97.06 100 99.9% 100 (NA) 99.9 (99.7–100) - - - - Nodjikouambaye et al 2019 ( 19 ) 126 12 90 4 91 95 92.8% 97 (80.7–93.3) 88 (80.7–93.3) - - - - Van Der Pol et al 2019 ( 30 ) 119 17 1769 1 87.5 99.9 - - - 99.2 (95.4–99.4) 99 (99.4–99.9) 98.6 (95.2–99.6) 99.1 (98.6–99.4) Human papilloma virus De Marais et al 2018 ( 27 ) (HSIL) - - - - - - 0.66 - - 100 (NA) 88.9 (83.6–93.0) 100 (NA) 90 (84.8–93.9) De Marais et al 2018 ( 27 ) (CIN 2) - - - - - - 0.66 - - 100 (NA) 91.1% (86–94.8) 100 (NA) 92.2% (87.3–95.7) Obiri-Yeboah et al., 2017 ( 38 ) - - - - - - 94.2 92.6 (85.3–97.0) 95.9 (89.8–98.8) - - - - Mycoplasma genitalium Camus et al 2021 ( 33 ) 14 0 0 1014 100 100 100% 100 (NA) 100 (NA) - - - - Nodjikouambaye et al 2019 ( 19 ) 126 12 90 4 91 95 - 97 (80.7–93.3) 88 (80.7–93.3) - - - - Neisseria gonorrhoea Arias et al 2016 ( 31 ) 0.8 4 180 1 17 99 98.4% 40 98.4 - - - - Camus et al 2021 ( 33 ) 7 1020 1021 1 0.68 99.9 99.9% 85.7 (59.9–100) 100 (NA) - - - - Nodjikouambaye et al 2019 ( 19 ) 126 12 90 4 91 95 86% 97 (80.7–93.3) 88 (80.7–93.3) - - - Van Der Pol et al 2019 ( 30 ) 28 0 1903 5 84.5 100 - - - 100 (87.9–99.9) 99.7 (99.3–99.9) 100 (87.9–100) 99.7 (99,4–99.9) Trichomoniasis vaginalis Camus et al 2021 ( 33 ) 9 1015 1015 0 0.88 100 99.8% 100 (NA) 99.8 (99.5–100) - - - - Hawash et al 2021 ( 34 ) 15 2 127 5 88.2 100 97.9% - - 83.3 (58.5–96.4) 98.4 (94.5–99.8) 88.8 (65.2–98.6) 100 (97.1–100) Khan et al 2019 ( 35 ) 3 0 547 0 100 100 100% 100 100 - - - - Nodjikouambaye et al 2019 ( 19 ) 126 12 90 4 91 95 92.8 97 (80.7–93.3) 88 (80.7–93.3) - - - - Schwebke et al., 2018 ( 29 ) (InPouch) 156 37 1593 5 80.8 99.7 - 96.90 (92.9–99.9) 97.70 (96.9–98.4) - - - - Schwebke et al., 2018 ( 29 ) (Aptima assay) 186 5 1593 7 96.4 99.7 - 97.4 (94.0–99.1) 99.6 (99.1–99.8) - - - - Schwebke et al., 2018 ( 29 ) (PIS) 186 7 1591 7 96.4 99.6 - 96.4 (92.7–98.5) 99.6 (99.1–99.8) - - - - Schwebke et al., 2018 ( 29 ) (Xpert vs PIS) 186 7 1591 7 96.4 99.6 - 96.4 (92.7–98.5) 99.6 (99.1–99.8) - - - - TP = True positive; FN = False positive; TN = True negative; FN = False negative; PPV = Positive predictive value; NPV = Negative predictive value; PIS = patient infected status The characteristics of the included studies were further divided into sub-groups for meta-analysis for each STI as outlined in the following sections: Chlamydia A total of six studies compared the diagnostic accuracy of self-collected specimens to healthcare worker collected specimens in females ( 19 , 27 , 30 , 31 , 33 , 37 ). Five of the studies were conducted in a clinic ( 19 , 27 , 31 , 33 , 37 ), and study location was not reported for one of the studies ( 30 ). Of these six studies, three of them compared healthcare worker collected vaginal swabs to self-collected vaginal swabs ( 30 , 31 , 33 ). In two of the studies healthcare workers collected cervical swabs were compared to self-collected cervicovaginal swabs ( 27 , 37 ). Only one study compared healthcare worker collected endocervical swabs to self-collected veil specimens ( 19 ). STI testing was performed using automated NAAT based assays. All six studies were cross-sectional studies. In five of the studies, research participants had received instructions on how to self-collect specimens for testing ( 19 , 27 , 31 , 33 , 37 ), and in one study the research participants did not receive any instructions ( 30 ). The number of research participants in the studies ranged from 189 to 3860. Only four of the six studies were included in the subgroup meta-analysis ( 19 , 30 , 31 , 33 ). Out of the two excluded studies, one study was excluded because only agreement data was reported and the other parameters were not reported ( 37 ). Similarly, the other study only reported sensitivity and specificity data ( 27 ). Figure 2 presents research findings for the subgroup analysis of four studies, where the summary estimate for sensitivity was 0.85 (95% Confidence Interval 0.77–0.92), while specificity was 0.95 (95% Confidence Interval 0.91–0.98). The SROC plot (Fig. 3 ) is a depiction of the pooled sensitivity and specificity of the studies. The studies show statistical significance in the studies, but there is moderate evidence of heterogeneity among the studies. The diagnostic tests have a good discriminatory ability to differentiate between individuals with and without chlamydia (Table 4 below) Table 4 Heterogeneity and statistical significance for CT Item Result P value 0.02. The result is significant at p < 0.05 Cochran’s Q (heterogeneity) 9.82 DOR 7.78 Human papilloma virus Five studies compared the diagnostic accuracy of healthcare worker collected specimens with self-collected specimens to diagnose HPV ( 27 , 28 , 32 , 36 , 38 ). Three of the studies compared healthcare worker collected cervical swabs were compared to self-collected vaginal swabs ( 32 , 36 , 38 ), while one study compared healthcare worker collected cervical swabs with self-collected tampons and vaginal swabs ( 28 ), and another study compared healthcare worker collected cervical swab with self-collected cervicovaginal swabs ( 27 ). All the studies were conducted in a research clinic. The sample size of the studies ranged from 151 to 1836 study participants. Study participants received instructions on how to self-collect their specimens for STI diagnosis, prior to specimen collection. NAAT based diagnostic assays were used in all the studies. Four of the studies were cross-sectional studies ( 28 , 32 , 36 ), and only one was a clinical trial ( 27 ). In one study, the sensitivity and specificity of self-collected specimens was 100% and 88.9% respectively, while healthcare worker collected diagnostic result sensitivity and specificity were 100% and 90% respectively ( 27 ). In another study, the sensitivity and specificity of self-collected specimens compared to healthcare worker collected specimens were 92.6% and 95.9% respectively( 38 ). One study reported the sensitivity of self-collected specimens as 100% ( 36 ). Another study reported the sensitivity and specificity of only self-collected swab as 86% and 94% respectively, while for the self-collected tampon it was 77% and 100% respectively ( 28 ). Another study reported sensitivity results of self-collected specimens as 89.1% and sensitivity of healthcare workers collected specimens as 87.9% ( 32 ). However, a sub-group meta-analysis was not performed because the relevant data for TN, FN, TP and FP was not available. Mycoplasma genitalium Out of the four studies that investigated MG infection, two studies compared self-collected cervicovaginal swabs with healthcare worker collected cervical swabs ( 27 , 37 ); one study compared healthcare worker collected vaginal and cervical swabs with self-collected vaginal swabs ( 33 ), and another one compared healthcare worker collected endocervical swabs with self-collected veil specimens ( 19 ). Diagnostic testing was performed using NAAT based assays in all the studies. All the studies were conducted in clinics. In all the studies, research participants received instructions on how to self-collect specimens before collecting their own specimens. The sample size ranged from 193 to 1028 participants. All studies were cross-sectional. Only two of the included studies had sufficient data for a meta-analysis for this subgroup ( 19 , 33 ). Figure 4 presents the analysis of the two studies where the summary estimate for sensitivity was 0.49 (95% Confidence Interval 0.39–0.58) and for specificity was 0.88 (95% Confidence Interval 0.81–0.94). Presented below in Fig. 5 is the SROC plot depicting the diagnostic accuracy of the studies in this subgroup. The sub-group meta-analysis suggests that the accuracy of the diagnostic test may vary across studies, with poor sensitivity in one study and poor specificity in the other. However, overall, the test shows a moderate to high diagnostic accuracy, as indicated by the high DOR value (Table 5 ). Table 5 Heterogeneity and statistical significance for MG Item Result P value 0.001. The result is significant at p < 0.05 Cochran’s Q (heterogeneity) 15.50 DOR 21.7 Gonorrhoea Seven studies investigated the diagnostic accuracy of self-collected specimens in comparison to healthcare worker collected specimens in diagnosing NG. Six of these studies were cross-sectional ( 26 , 31 , 33 , 37 ) ( 19 , 30 ), and only one was a clinical trial ( 27 ). The sample size of the studies ranged from 89 to 3860. Laboratory diagnosis was performed using automated NAAT based assays in all the studies, and one of the studies also used manual diagnostic methods ( 26 ). Six studies reported that specimen collection had occurred at research clinics ( 19 , 26 , 27 , 31 , 33 , 37 ), and one study did not indicate ( 30 ). In six of the studies, research participants received instructions before specimen collection ( 19 , 26 , 27 , 31 , 33 , 37 ), but in one study there was no report about whether research participants had been instructed how to self-collect their specimen ( 30 ). Two studies compared diagnostic accuracy in healthcare worker collected vaginal swabs to self-collected vaginal swabs ( 30 , 31 ). One study compared self-collected vaginal swabs to cervical and vaginal swabs collected by healthcare workers ( 33 ). Two studies compared diagnostic accuracy in self-collected cervicovaginal swabs and healthcare worker collected cervical swabs ( 27 , 37 ). In one study diagnostic accuracy is compared between healthcare worker collected endocervical swabs with self-collected vaginal swabs ( 26 ). Another study compared diagnostic accuracy in self-collected veil specimens with healthcare worker collected endocervical swabs ( 19 ). Figure 6 below presents summary estimates for the sensitivity and specificity of diagnostic accuracy of healthcare worker collected specimens compared to self-collected specimens. The summary estimate for sensitivity and specificity is 0.59 (95% Confidence Interval 0.49–0.68) and 0.84 (95% Confidence Interval 0.76–0.91). Presented below in Fig. 7 is the SROC plot depicting the diagnostic accuracy of the studies in this subgroup. The Cochran's Q test shows significant heterogeneity among the studies at 17.156. The diagnostic odds ratio of 2.579 suggests that the overall accuracy of the diagnostic test is low to moderate. The p-value indicates statistical significance. See Table 6 below: Table 6 Heterogeneity and statistical significance for NG Item Result P value 0.0006. The result is significant at p < 0.05 Cochran’s Q (heterogeneity) 17.156 DOR 2.579 Trichomoniasis Seven studies investigated the diagnostic accuracy of self-collected specimens in comparison to healthcare worker collected specimens in diagnosing trichomoniasis. Six of the studies were cross-sectional ( 19 , 29 , 33 , 34 , 35 , 37 ), and one study was a clinical trial ( 27 ). Four studies utilised automated NAAT-based assays ( 19 , 27 , 33 , 37 ), one study used manual testing methods ( 35 ), while two studies used both automated NAAT assays and manual methods for TV diagnosis ( 29 , 34 ). Study participants in all the studies collected their specimens at the research clinics. In five of the studies the participants received instructions on how to self-collect specimens before collecting their specimens ( 19 , 27 , 33 , 34 , 35 , 37 ), and in one study this was not reported ( 29 ). The sample size of research participants ranged from 174–1867. One study compared the diagnostic accuracy of healthcare worker collected vaginal and cervical swabs with self-collected swabs ( 33 ). Two studies compared healthcare worker collected cervical swabs with self-collected vaginal swabs ( 29 , 37 ). One study compared endocervical swabs collected by healthcare workers with self-collected veil specimens ( 19 ). Two studies compared diagnostic accuracy between self-collected vaginal swabs with healthcare worker collected vaginal swabs ( 34 , 35 ). Only one study compared healthcare worker collected endocervical swabs with self-collected vaginal swabs ( 19 ). Figure 8 below presents summary estimates for the sensitivity and specificity of diagnostic accuracy healthcare worker collected specimens compared to self-collected specimens. The summary estimate for sensitivity and specificity is 0.94 (95% Confidence Interval 0.89–0.98) and 0.91 (95% Confidence Interval 0.85–0.96) respectively and it is depicted on the SROC in Fig. 9 below. Additionally, Fig. 9 depicts the diagnostic accuracy of the studies in this subgroup. The Cochran's Q test result shows that there is significant heterogeneity among the studies and the diagnostic test is moderately accurate in identifying patients with disease (Table 7 ). Table 7 Heterogeneity and statistical significance for TV Item Result P value 0.001. The result is significant at p < 0.05 Cochran’s Q (heterogeneity) 25.15 DOR 20.02 Table 8: QUADAS-2 Summary of methodological assessment Study RISK OF BIAS APPLICABILITY CONCERNS PATIENT SELECTION INDEX TEST REFERENCE STANDARD FLOW AND TIMING PATIENT SELECTION INDEX TEST REFERENCE STANDARD Arias et al 2016 L J J J J J J Barbee et al 2021 L J J J J J J Boggan et al 2015 L J J J J J ? Camus et al 2021 J J J J J J ? De Marais et al 2018 L J J J J J ? Hawash et al 2021 L J J J J J ? Lockhart et al 2018 ? J J J J J ? Khan et al 2019 J J ? J J J ? Kim et al 2020 L J J J J J ? McLarty et al 2019 L J J J J J J Nodjikouambaye et al 2019 L J J J J J ? Obiri-Yeboah et al 2017 L J ? J J J ? Schwebke et al 2017 L J ? J J J ? Van Der Pol et al 2019 L J J J J J ? Methodological quality of studies Table 8 below depicts the risk of bias and applicability assessment of included studies using the QUADAS-2 tool used to assess quality ( 25 ). The domains of the QUADAS-2 tool are patient selection, index test, reference standard, and flow and timing. Patient selection outlines the process of selecting study participants in the primary studies which includes setting, presentation, prior testing, and intended use of index test; index test describes how the test of interest was conducted and interpreted; reference standard describes how the standard test was conducted and interpreted, and flow and timing describe excluded studies and intervals between the index and reference tests ( 25 ). For the current study, the index test is designated as the self-collected specimens, while the reference test refers to the healthcare worker collected specimens. For the majority of the studies, the sampling approach utilised was convenience sampling and not random or consecutive sampling which are the options available in the patient selection domain. Although convenience sampling was used for most of the studies and therefore introduced a high-risk bias, that is unlikely to interfere with the diagnostic accuracy of self-sampling and healthcare worker collected specimens. The reference standard domain and flow and timing domains were found to mostly be at low risk of bias in all the studies. Concerning applicability, all studies were at low risk of bias. However, regarding the applicability of the reference standard, it was unclear for most studies. The graphical results of the included studies from the QUADAS-2 quality assessment tool are indicated in Fig. 10 . Discussion This study compared the diagnostic accuracy of self-collected specimens to healthcare worker collected specimens for diagnosing CT, HPV, MG, NG, syphilis, and TV in females. No studies on syphilis fulfilled the eligibility criteria for inclusion in this review. For CT, six studies were included in the analysis, out of which four were included in the subgroup meta-analysis. The summary estimate for sensitivity was 0.85 (0.77–0.92), while specificity was 0.95 (0.91–0.98). For HPV, five studies were included, and there was insufficient data to perform a sub-group meta-analysis. However, the sensitivity and specificity of self-collected specimens of the individual studies compared to healthcare worker collected specimens varied between studies, with sensitivity ranging from 86–100%, and specificity ranging from 88.9–100%. For MG, four studies investigated diagnostic accuracy, and two studies had sufficient data for a sub-group meta-analysis. The summary estimate for sensitivity was low at 0.49 (0.39–0.58), while specificity was 0.88 (0.81–0.94). For NG, seven studies were included in the analysis, and four studies were included in the sub-group meta-analysis. The pooled sensitivity and specificity estimate was 0.59 (0.49–0.68) and 0.84 (0.76–0.91) respectively. In the case of CT and NG, it is important to note that the low sensitivity and high specificity are comparable to previous findings ( 15 ). For TV, seven studies investigated diagnostic accuracy, and four studies were included in the sub-group meta-analysis. The results of the meta-analysis showed that self-collected specimens have high sensitivity and specificity for the diagnosis of trichomoniasis, with a summary estimate for sensitivity and specificity of 0.94 (0.89–0.98) and 0.91 (0.85–0.96), respectively. The study found that there was significant heterogeneity among the studies. This may be attributed to differences in the methods used to collect and test specimens across the different studies. The DOR results indicated that the diagnostic tests used in the studies had a good ability to differentiate between individuals with and without CT, HPV, NG, MG and TV. The study also presented a SROC curve to visualize the sensitivity and specificity of all included studies, with most points falling between 0.9 and 1.00 on the y-axis (sensitivity), indicating better performance in distinguishing between the presence and absence of infection. The QUADAS-2 tool was used to assess the quality of the included studies, and it showed that a majority of them used convenience sampling to select patients. Although this sampling method can increase the risk of bias, it did not appear to affect the diagnostic accuracy of self-collected specimens and specimens collected by healthcare workers. Most of the included studies had a low risk of bias in the index test, reference standard, flow, and timing domains. Overall, the included studies introduced minimal bias, which enhances the quality of the research findings. Study screening, selection, and data extraction were conducted systematically to ensure the most suitable studies were included in the review. A comprehensive approach to reviewing existing evidence on the diagnostic accuracy of self-collected specimens versus those collected by healthcare workers was employed. Only peer-reviewed and published studies were included to ensure reliable results. Some of the included studies utilized convenience sampling, which may have introduced bias in the patient selection process. Since we classified healthcare worker collected specimens as the gold-standard diagnostic accuracy was presumed to be 100%. For CT the healthcare worker collected sensitivity ranged between 50% and 100%, while specificity was 88% and 99.2%; for MG sensitivity ranged between 97% and 100%, while specificity was 88% and 100%; NG sensitivity ranged between 40% and 97%, while specificity was 88% and 100%; and TV sensitivity ranged between 96% and 100%, while specificity was 88% and 100%. The results indicate that self-collected specimens are a comparative alternative to healthcare worker collected specimens for STI testing. This is in keeping with previous studies that advocate for the use of self-sampling interventions as alternative tools to enable and promote screening of STIs even in asymptomatic patients and resource- limited settings ( 15 , 39 ). These findings have important implications for STI testing, particularly in settings where access to healthcare workers may be limited or where stigma and embarrassment may prevent individuals from seeking testing. Conclusion This study presents evidence of the accuracy of self-collected specimens when used to diagnose STIs in females. The meta-analysis findings highlight that the diagnostic accuracy of self-collected specimen to diagnose STIs in females is comparable with that of healthcare worker collected specimens. When considering the global burden of STIs on the public health system, such findings are an indication of how self-sampling for STI diagnosis could be used to improve STI management services across the globe. Although much evidence exists on the use of this intervention in high-income countries ( 22 ), the researchers hope that the findings of this study will capture the attention of governments in LIMCs and cause them to see their need for it. Furthermore, the potential of self-sampling interventions to improve screening of asymptomatic STIs must be recognized and utilized as a tool to fulfil goal 3 of the sustainable development goals which is targeted at treating and improving access to quality healthcare for all people across the globe. The study is limited in that the investigation of diagnostic accuracy of self-collected specimens was only conducted on females. Therefore, the findings are not representative of self-collected specimens among a broader and more diverse population. We, therefore, recommend a future study to investigate the accuracy of self-collected specimens for diagnosing a wide range of STIs in a more diverse and broader population. Abbreviations CT: Chlamydia trachomatis CIN2: Cervical intraepithelial neoplasia 2 DOR: Diagnostics Odds Ratio DoH SA: Department of Health South Africa FP: False positive FN: False negative HPV: Human papilloma virus HSIL: High grade squamous intraepithelial lesion LMICs: Low-and-middle-income countries MeSH: Medical Subject Headings MG: Mycoplasma genitalium NAAT: Nucleic acid amplification test NG: Neisseria gonorrhoea NPV: Negative predictive value PCR: Polymerase chain reaction PI: Principal investigator PIS: Patient infected status PICO: Population Intervention Comparison Outcome PPV: Positive predictive value PRISMA: Preferred Reporting Items for Systematic Review and Meta-analyses QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies 2 RevMan: Review manager STI: Sexually transmitted infections SROC: Summary receiver operating characteristic TN: True negative TP: True positive TV: Trichomonas vaginalis WHO: World Health Organization Declarations Ethics approval and consent to participate: Ethical clearance for the study was obtained from the University of Pretoria’s Faculty of Health Sciences Research Ethics Committee. The reference number is 136/2022. Participant consent was not applicable. Consent for publication: Not applicable Availability of data and materials: All data generated or analysed during this study are included in this manuscript [and its supplementary information files]. Competing interests: There are no competing interests Funding: No funding was received from any funding agencies in public, commercial, or non-profit sectors Authors' contributions: Conceptualization, Z.N.J. and T.M.-T.; developing and conducting the search strategy, K.K; screening, Z.N.J., T.D., and NT.; writing - original draft, Z.N.J.; writing—reviewing and editing, T.M.-T., W.M., T.Dz.; supervision, T.M.-T and W.M. All authors have read and agreed to the current version of the manuscript. Acknowledgements: The authors wish to thank the University of Pretoria and Mangosuthu University of Technology for providing all the necessary resources for developing this review. References Organization WH. Report on global sexually transmitted infection surveillance 2018. 2018. Van Gerwen OT, Muzny CA, Marrazzo JM. Sexually transmitted infections and female reproductive health. Nature Microbiology. 2022;7(8):1116-26. Organization WH. Sexually transmitted infections: implementing the global STI strategy. World Health Organization; 2017. WHO. Sexually transmitted infections (STIs): key facts. 2016. Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PloS one. 2015;10(12):e0143304. Organization WH. Sexually transmitted infections (STIs): the importance of a renewed commitment to STI prevention and control in achieving global sexual and reproductive health. World Health Organization; 2013. Røttingen J-A, Cameron DW, Garnett GP. A Systematic Review of the Epidemiologie Interactions Between Classic Sexually Transmitted Diseases and HIV: How Much Really Is Known? Sexually transmitted diseases. 2001:579-97. Garrett NJ, McGrath N, Mindel A. Advancing STI care in low/middle-income countries: has STI syndromic management reached its use-by date? : BMJ Publishing Group Ltd; 2017. p. 4-5. Organization WH. Guidelines for the management of symptomatic sexually transmitted infections: World Health Organization; 2021. Organization WH. Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus World Health Organisation; 2013. Contract No.: World Health Organisation. Paudyal P, Llewellyn C, Lau J, Mahmud M, Smith H. Obtaining self-samples to diagnose curable sexually transmitted infections: a systematic review of patients’ experiences. PloS one. 2015;10(4):e0124310. Garrett NJ, Osman F, Maharaj B, Naicker N, Gibbs A, Norman E, et al. Beyond syndromic management: opportunities for diagnosis-based treatment of sexually transmitted infections in low-and middle-income countries. PloS one. 2018;13(4):e0196209. Chauhan V, Shah MC, Patel SV, Marfatia YS, Zalavadiya D. Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. Indian Journal of Sexually Transmitted Diseases and AIDS. 2016;37(1):28. Murewanhema G, Moyo E, Mhango M, Chitungo I, Moyo P, Musuka G, et al. Abnormal vaginal discharge among women of reproductive age in sub-Saharan Africa: the need for a paradigm shift from a syndromic approach to specific pathogen identification and directed treatment. IJID Regions. 2022;5:165-8. Lunny C, Taylor D, Hoang L, Wong T, Gilbert M, Lester R, et al. Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis. PLoS One. 2015;10(7):e0132776. Garland SM, Tabrizi SN. Diagnosis of sexually transmitted infections (STI) using self-collected non-invasive specimens. Sexual health. 2004;1(2):121-6. Griner SB, Beckstead JW, Vamos CA, Puccio JA, Perrin K, Daley EM. Characteristics associated with the adoption of consumer-based self-sampling methods for sexually transmitted infection screening. Journal of American College Health. 2022:1-8. Harding-Esch EM, Hollis E, Mohammed H, Saunders JM. Self-sampling and self-testing for STIs and HIV: the case for consistent nomenclature. Sexually transmitted infections. 2016. Nodjikouambaye ZA, Compain F, Sadjoli D, Mboumba Bouassa R-S, Péré H, Veyer D, et al. Accuracy of curable sexually transmitted infections and genital mycoplasmas screening by multiplex real-time PCR using a self-collected veil among adult women in Sub-Saharan Africa. Infectious diseases in obstetrics and gynecology. 2019;2019. Würstle S, Spinner CD, Voit F, Hoffmann D, Hering S, Weidlich S, et al. Self-sampling versus health care professional-guided swab collection for SARS-CoV-2 testing. Infection. 2021;49(5):927-34. Ogale Y, Yeh PT, Kennedy CE, Toskin I, Narasimhan M. Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ global health. 2019;4(2):e001349. Jaya ZN, Mapanga W, van Niekerk B, Dlangalala T, Kgarosi K, Dzobo M, et al. Mapping Evidence of Self-Sampling to Diagnose Sexually Transmitted Infections in Women: A Scoping Review. Diagnostics. 2022;12(8):1803. Ogilvie G, Patrick D, Schulzer M, Sellors J, Petric M, Chambers K, et al. Diagnostic accuracy of self collected vaginal specimens for human papillomavirus compared to clinician collected human papillomavirus specimens: a meta-analysis. Sexually transmitted infections. 2005;81(3):207-12. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery. 2021;88:105906. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529-36. Barbee LA, Golden MR, Thibault CS, McNeil CJ, Soge OO. Performance of patient-collected specimens for Neisseria gonorrhoeae culture. Clinical Infectious Diseases. 2021;73(9):e3196-e200. Des Marais AC, Zhao Y, Hobbs MM, Barclay L, Brewer NT, Smith JS. Home self-collection by mail to test for human papillomavirus and sexually transmitted infections. Obstetrics and gynecology. 2018;132(6):1412. McLarty JW, Williams DL, Loyd S, Hagensee ME. Cervical Human Papillomavirus Testing With Two Home Self-Collection Methods Compared With a Standard Clinically Collected Sampling Method. Sexually Transmitted Diseases. 2019;46(10):670-5. Schwebke JR, Gaydos C, Davis T, Marrazzo J, Furgerson D, Taylor S, et al. Clinical evaluation of the Cepheid Xpert TV assay for detection of Trichomonas vaginalis with prospectively collected specimens from men and women. Journal of clinical microbiology. 2018;56(2):e01091-17. Van Der Pol B, Fife K, Taylor SN, Nye MB, Chavoustie SE, Eisenberg DL, et al. Evaluation of the performance of the cobas CT/NG test for use on the cobas 6800/8800 systems for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male and female urogenital samples. Journal of clinical microbiology. 2019;57(4):e01996-18. Arias M, Dan J, Gilchrist J, Luinstra K, Li J, Smieja M, et al. Ease, comfort, and performance of the HerSwab vaginal self-sampling device for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae. Sexually Transmitted Diseases. 2016;43(2):125-9. Boggan JC, Walmer DK, Henderson G, Chakhtoura N, McCarthy SH, Beauvais HJ, et al. Vaginal self-sampling for HPV infection as a primary cervical cancer screening tool in a Haitian population. Sexually transmitted diseases. 2015;42(11):655. Camus C, Penaranda G, Khiri H, Camiade S, Molet L, Lebsir M, et al. Acceptability and efficacy of vaginal self-sampling for genital infection and bacterial vaginosis: A cross-sectional study. PloS one. 2021;16(11):e0260021. Hawash Y, Jaafer N, Alpakistany T. Ease of use and validity testing of a point-of-care fast test for parasitic vaginosis self-diagnosis. Tropical Biomedicine. 2021;38(4):491-8. Khan Z, Bhargava A, Mittal P, Bharti R, Puri P, Khunger N, et al. Evaluation of reliability of self-collected vaginal swabs over physician-collected samples for diagnosis of bacterial vaginosis, candidiasis and trichomoniasis, in a resource-limited setting: a cross-sectional study in India. BMJ open. 2019;9(8):e025013. Kim MH, Jung HJ, Park SI, Kim BJ. Self‐obtained vaginal samples for HPV DNA testing to detect HPV‐related cervical disease. International Journal of Gynecology & Obstetrics. 2021;154(1):127-32. Lockhart A, Psioda M, Ting J, Campbell S, Mugo N, Kwatampora J, et al. Prospective evaluation of cervicovaginal self-and cervical physician collection for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium infections. Sexually transmitted diseases. 2018;45(7):488. Obiri-Yeboah D, Adu-Sarkodie Y, Djigma F, Hayfron-Benjamin A, Abdul L, Simpore J, et al. Self-collected vaginal sampling for the detection of genital human papillomavirus (HPV) using careHPV among Ghanaian women. BMC women's health. 2017;17(1):1-6. Ni Y, Lu Y, He X, Li Y, Li Y, Guo S, et al. Self-sampled specimens demonstrate comparable accuracy and consistency to clinician-sampled specimens for HPV detection among men who have sex with men in China. Sexually Transmitted Infections. 2022. 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Mashamba-Thompson\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Pretoria\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tivani\",\"middleName\":\"\",\"lastName\":\"Mashamba-Thompson\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-01-29 18:59:05\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-3909356/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-3909356/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1038/s41598-024-61358-y\",\"type\":\"published\",\"date\":\"2024-05-07T21:18:11+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":51531326,\"identity\":\"71e25720-8622-4a00-9a2c-ac7dfcccc00f\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:44:35\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":57600,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003ePRISMA flow diagram of the selection process of relevant studies\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/a83beef2907978e26810e150.png\"},{\"id\":51531327,\"identity\":\"34d3ddb9-c865-4f10-9b2f-4e7ea5fa91eb\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:44:35\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":53826,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eForest plot of chlamydia studies that compared self-collected vaginal swabs with healthcare worker collected cervical and vaginal specimens\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/d5b0bf2550509e99b896048a.png\"},{\"id\":51531606,\"identity\":\"3d38eee7-15fb-45ee-859c-f4475a38e93c\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:52:35\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":14677,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSROC depicting diagnostic accuracy of included studies for chlamydia\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/8d895f432a56d4337e312c46.png\"},{\"id\":51531330,\"identity\":\"684a02dd-0823-4fb2-9411-87e531b564c2\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:44:35\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":42913,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eForest plot of MG studies that compared self-collected vaginal swabs with healthcare worker collected cervical and vaginal specimens\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/7d6f10032c486788e03a08f5.png\"},{\"id\":51531332,\"identity\":\"6cb20f61-fa35-44d3-9c0f-094f96bab1c9\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:44:35\",\"extension\":\"png\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":15913,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSROC depicting diagnostic accuracy of MG in included studies\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"5.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/e1a177ae380d5629543d0a5c.png\"},{\"id\":51531335,\"identity\":\"ea7c6a04-d1b5-46f4-9414-2162e0a18203\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:44:35\",\"extension\":\"png\",\"order_by\":6,\"title\":\"Figure 6\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":45458,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eForest plot of gonorrhoea studies that compared self-collected vaginal swabs with healthcare worker collected cervical and vaginal specimens\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"6.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/2b9b7bad561e19fdb07c867b.png\"},{\"id\":51531607,\"identity\":\"020b966b-8763-4e23-890c-fe978bf9d752\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:52:35\",\"extension\":\"png\",\"order_by\":7,\"title\":\"Figure 7\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":19328,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSROC depicting diagnostic accuracy of NG in included studies\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"7.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/f16668152ee4808f924d7e42.png\"},{\"id\":51531333,\"identity\":\"43b93deb-77bb-4167-9107-28ec177bc0ec\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:44:35\",\"extension\":\"png\",\"order_by\":8,\"title\":\"Figure 8\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":76713,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eForest plot of TV studies that compared self-collected vaginal swabs with healthcare worker collected cervical and vaginal specimens\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"8.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/a58e18ead523aaa789d63a0d.png\"},{\"id\":51531334,\"identity\":\"ecf96e97-1445-4dff-b508-157b949bcb33\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:44:35\",\"extension\":\"png\",\"order_by\":9,\"title\":\"Figure 9\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":18469,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSROC depicting diagnostic accuracy of TV in included studies\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"9.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/a870ae30b75186ada1403d74.png\"},{\"id\":51531336,\"identity\":\"4660b026-e011-4c52-ab3d-743441c356ce\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:44:36\",\"extension\":\"png\",\"order_by\":10,\"title\":\"Figure 10\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":46973,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eAssessment of included studies using QUADAS-2\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"10.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/e8d85d79d39fe9f56cd58ee4.png\"},{\"id\":56488459,\"identity\":\"94897f18-ae41-4fe5-8335-5cb0b0f611c7\",\"added_by\":\"auto\",\"created_at\":\"2024-05-14 21:32:29\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1970567,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/de875974-6da2-4cc4-8864-b80ea79c6f70.pdf\"},{\"id\":51531329,\"identity\":\"d7ab014d-ec9f-4bf3-b9fa-93c789281d33\",\"added_by\":\"auto\",\"created_at\":\"2024-02-23 07:44:35\",\"extension\":\"xlsx\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":28314,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Supplementarymaterialsubmitted.xlsx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3909356/v1/13d00d3eb8157dd9b1f9c150.xlsx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Accuracy of self-collected versus healthcare worker collected specimens for diagnosing sexually transmitted infections: an updated systematic review and meta-analysis\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eSexually transmitted infections (STIs) are a major global health concern that causes symptomatic and asymptomatic infections (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). Most STIs caused by bacteria and parasites are curable if diagnosed and treated accordingly but most viral STIs are incurable (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). The largest portion of STIs occurs in females across the globe (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). In females, the consequence of undiagnosed and untreated STIs can result in reproductive health complications that include infertility, stillbirths, cancer development and increased susceptibility to HIV (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). Considering this, our study focused on STIs in females.\\u003c/p\\u003e \\u003cp\\u003eGovernments across the globe, particularly in low-and-middle-income countries (LMICs) continue to use syndromic management of STIs due to a scarcity of resources and restricted access to diagnostic laboratories (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). This approach relies on reported signs and symptoms, and physical examinations for diagnosis and then treatment is issued for the most common STIs (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e). In light of this, it deters infected individuals who fear invasive genital examinations and stigmatization associated with STIs (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). Additionally, this approach cannot address asymptomatic infections because these individuals may not seek care (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). As such, asymptomatic individuals continue to spread infection and become susceptible to long term STI complications. Syndromic management often promotes over-diagnosing and over-treating because treatment is issued often targeting the most common STI causative pathogens instead of a specific pathogen (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). As such Murewanhena et al. (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e) suggest a shift from syndromic management of STIs to a more pathogen specific diagnosis and treatment of STIs. The development of innovative alternative interventions, such as self-sampling, is key to improving STI healthcare service provision (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). Self-sampling enables individuals to self-collect specimens for STI diagnosis either at home or healthcare facilities or in places where they are comfortable (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). This intervention can be used to screen for asymptomatic infections (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e), and screen infections in remote areas where access to quality healthcare is limited (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e). Based on this, self-sampling can address the challenges linked to the syndromic management of STIs (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e). However, self-sampling may jeopardise specimen quality since the collection is performed by inexperienced individuals.\\u003c/p\\u003e \\u003cp\\u003eSince the potential of self-sampling interventions for STI diagnosis is evident, it is imperative to determine their diagnostic accuracy and reliability. A scoping review conducted by Jaya et al (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e) in 2021 presented evidence that supports self-sampling interventions as appropriate alternatives to physician collected specimens for STI diagnosis. A meta-analysis conducted in 2005 proved that self-collected swabs were suitable alternatives to clinician-collected specimens for the diagnosis of human papillomavirus (HPV) (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e). A systematic review and meta-analysis conducted in 2015 on \\u003cem\\u003eNeisseria gonorrhoea\\u003c/em\\u003e (NG) and \\u003cem\\u003eChlamydia trachomatis\\u003c/em\\u003e (CT) also reported that self-collected specimens were reliable for diagnostic testing (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). Considering the potential impact of the self-sampling intervention on sexual and reproductive healthcare there is a need for an updated systematic review and meta-analysis sexual and reproductive healthcare. This is to foster improvements in clinical decision-making pertaining to sexual and reproductive healthcare provision. As such, the current study is an updated systematic review and meta-analysis on the accuracy of self-collected specimens compared to healthcare worker-collected specimens for STI diagnosis. This study will evaluate the diagnostic accuracy of self-sampling for STI diagnosis in studies conducted from 2015 onwards because a systematic review of a similar nature included studies up to 2015. The overarching aim of an updated systematic review is to ensure that the best evidence to inform clinical decision making and healthcare policy development for STI healthcare is provided.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eProtocol and registration\\u003c/h2\\u003e \\u003cp\\u003e The protocol for this study was submitted to the International Registration of Systematic Reviews (PROSPERO), with the registration number CRD42022341462. This study was guided by the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eEligibility criteria\\u003c/h2\\u003e \\u003cp\\u003eThe Population, Intervention, Comparison, and Outcome (PICO) framework for determining the research question eligibility was followed. Studies were included if they: a) assessed the accuracy of self-collected specimens against healthcare worker-collected specimens for STI diagnosis in women were included, b) studies that used healthcare worker collected specimens as the reference or gold standard, c) the study population comprised of specimens that had been tested for STIs including HPV, NG, CT, \\u003cem\\u003eTreponema pallidum\\u003c/em\\u003e (syphilis), \\u003cem\\u003eTrichomonas vaginalis\\u003c/em\\u003e (TV), and \\u003cem\\u003eMycoplasma genitalium\\u003c/em\\u003e (MG), d) examined self-collected versus clinician-collected samples using different diagnostic assays including nucleic-acid-based assays, and manual methods that included wet mount, culture, and gram stain peer-reviewed studies published in 2015 and onwards to diagnose STIs. Data on investigations conducted on females will be extracted from studies that include people of another gender. There were no language restrictions applied and studies with different study designs were included. Studies were excluded if: a) the time of self-sampling and healthcare worker specimen collection exceeded three weeks due to the window period for seroconversion, b) presented information on combined specimen results, c) self-sampling was not conducted in females, d) self-sampling and healthcare worker collected specimen was collected from different individuals.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eIndex test\\u003c/h2\\u003e \\u003cp\\u003eThe diagnostic accuracy of self-collected specimens to diagnose STIs was evaluated against healthcare worker specimens. Self-collected specimens for STI diagnosis included vaginal swabs, urine, cervical swabs and tampons. The sensitivity and specificity of each diagnostic assay for each STI were evaluated.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eReference standard\\u003c/b\\u003e \\u003c/p\\u003e \\u003cp\\u003eHealthcare worker-collected specimens for the diagnosis of STIs were used as the gold reference standard in this study.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSearch strategy\\u003c/h2\\u003e \\u003cp\\u003eA systematic search of data was conducted in Cochrane, Medline, Scopus, Web of Science, PubMed, and Wed of Science electronic databases (see Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). The search was limited to studies from 2015 onwards. The Principal Investigator (PI) developed the search strategy with an experienced librarian at the University of Pretoria. Medical Subject Headings (MeSH) terms were used to define our searches with Boolean operators (AND/OR) between search terms. The search terms used included but were not limited to 1) \\u0026ldquo;Self-sampling\\u0026rdquo; or \\u0026ldquo;self-collected\\u0026rdquo; or \\u0026lsquo;self-administered\\u0026rdquo; or \\u0026ldquo;self-obtained\\u0026rdquo; 2) \\u0026ldquo;sexually transmitted infections\\u0026rdquo; 3) \\u0026ldquo;diagnostic specimens\\u0026rdquo; or \\u0026ldquo;diagnostic samples\\u0026rdquo; 4) \\u0026ldquo;women\\u0026rdquo; or \\u0026ldquo;females\\u0026rdquo;. A hand search for grey literature was also conducted on the WHO website, the Department of Health South Africa (DoH SA), and the Open Grey website.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDatabase search\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDate\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDatabase\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eKeywords\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNumber of results retrieved\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e14 July 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eScopus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e( TITLE-ABS-KEY ( sampling OR sample OR \\\"self sampling\\\" OR \\\"self sample\\\" OR \\\"sti testing\\\" OR \\\"sti diagnosis\\\" OR \\\"sexually transmitted infections test*\\\" OR \\\"self-collect*\\\" OR \\\"sexually transmitted disease testing*\\\" ) AND TITLE-ABS-KEY ( \\\"Specimen Handling\\\" ) AND TITLEABS-KEY ( \\\"Sexually Transmitted Disease*\\\" OR \\\"sexually transmitted infection*\\\" ) AND TITLE-ABS-KEY ( wom*n OR female* OR girl* ) AND NOT TITLE-ABS-KEY ( aids OR \\\"HIV Infections\\\" OR hiv OR \\\"human immunodeficiency virus\\\" OR \\\"acquired immunodeficiency syndrome\\\" ) )\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e117\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e15 July 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCochrane\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(sampling OR sample OR \\\"self sampling\\\" OR \\\"self sample\\\" OR \\\"sti testing\\\" OR \\\"sti diagnosis\\\" OR \\\"sexually transmitted infections test*\\\" OR \\\"selfcollect*\\\" OR \\\"sexually transmitted disease testing*\\\"):ti,ab,kw (Word variations have been searched)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e19 July 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePubMed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(((sampling[tw] OR sample[tw] OR \\\"self sampling\\\"[tw] OR \\\"self sample\\\"[tw] OR \\\"sti testing\\\"[tw] OR \\\"sti diagnosis\\\"[tw] OR \\\"sexually transmitted infections test*\\\"[tw] OR \\\"self-collect*\\\"[tw] OR \\\"sexually transmitted disease testing*\\\"[tw] AND (female[Filter])) AND (\\\"Specimen Handling/methods\\\"[Mesh] OR \\\"Specimen Handling\\\"[tw] AND (female[Filter]))) AND (\\\"Sexually Transmitted Diseases, Bacterial\\\"[Mesh] OR \\\"Sexually Transmitted Diseases, Viral\\\"[Mesh] OR \\\"sexually transmitted infection*\\\"[tw] OR \\\"sexually transmitted disease*\\\"[tw])) NOT (\\\"HIV Infections\\\"[Mesh] OR \\\"HIV Infections\\\"[tw])\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e213\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e19 July 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eWb of Science\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e((((ALL=(sampling OR sample OR \\\"self sampling\\\" OR \\\"self sample\\\" OR \\\"sti testing\\\" OR \\\"sti diagnosis\\\" OR \\\"sexually transmitted infections test*\\\" OR \\\"self-collect*\\\" OR \\\"sexually transmitted disease testing*\\\")) AND ALL=( \\\"Sexually Transmitted Disease*\\\" OR \\\"sexually transmitted infection*\\\" OR STI OR STD)) AND ALL=(wom*n OR female* OR girl*)) AND ALL=(\\\"Specimen Handling\\\" or \\\"Specimen Collection\\\" OR Specimen)) NOT ALL=(aids OR \\\"HIV Infections\\\" OR hiv OR \\\"human immunodeficiency virus\\\" OR \\\"acquired immunodeficiency syndrome\\\")\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e311\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e21 July 2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMEDLINE (EBSCO)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(((ALL=(sampl* OR \\\"self sampl*\\\" OR \\\"sti test*\\\" OR \\\"sti diagnosis\\\" OR \\\"sexually transmitted infections test*\\\" OR \\\"self-collect*\\\" OR \\\"sexually transmitted disease test*\\\"))) AND ALL=( ) NOT ALL=(\\\")\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e140\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e26 Aug 2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePubMed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(((sampling[tw] OR sample[tw] OR \\\"self sampling\\\"[tw] OR \\\"self sample\\\"[tw] OR \\\"sti testing\\\"[tw] OR \\\"sti diagnosis\\\"[tw] OR \\\"sexually transmitted infections test*\\\"[tw] OR \\\"self-collect*\\\"[tw] OR \\\"sexually transmitted disease testing*\\\"[tw]) AND (\\\"Specimen Handling/methods\\\"[Mesh] OR \\\"Specimen Handling\\\"[tw])) AND (\\\"Sexually Transmitted Diseases, Bacterial\\\"[Mesh] OR \\\"Sexually Transmitted Diseases, Viral\\\"[Mesh] OR \\\"sexually transmitted infection*\\\"[tw] OR \\\"sexually transmitted disease*\\\"[tw])) NOT (\\\"HIV Infections\\\"[Mesh] OR \\\"HIV Infections\\\"[tw]) Filters: Female, from 2021\\u0026ndash;2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e26 August 2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eWeb of Science\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e((((ALL=(sampling OR sample OR \\\"self sampling\\\" OR \\\"self sample\\\" OR \\\"sti testing\\\" OR \\\"sti diagnosis\\\" OR \\\"sexually transmitted infections test*\\\" OR \\\"self-collect*\\\" OR \\\"sexually transmitted disease testing*\\\")) AND ALL=( \\\"Sexually Transmitted Disease*\\\" OR \\\"sexually transmitted infection*\\\" OR STI OR STD)) AND ALL=(wom*n OR female* OR girl*)) AND ALL=(\\\"Specimen Handling\\\" or \\\"Specimen Collection\\\" OR Specimen)) NOT ALL=(aids OR \\\"HIV Infections\\\" OR hiv OR \\\"human immunodeficiency virus\\\" OR \\\"acquired immunodeficiency syndrome\\\")\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e26 August 2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMEDLINE (EBSCO)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e( sampling OR sample OR \\\"self sampling\\\" OR \\\"self sample\\\" OR \\\"sti testing\\\" OR \\\"sti diagnosis\\\" OR \\\"sexually transmitted infections test*\\\" OR \\\"self-collect*\\\" OR \\\"sexually transmitted disease testing*\\\" ) AND ( (MH \\\"Sexually Transmitted Diseases+\\\") OR \\\"Sexually Transmitted Disease*\\\" OR \\\"sexually transmitted infection*\\\" OR STI OR STD ) AND ( \\\"Specimen Handling\\\" OR (MH \\\"Specimen Handling+\\\") ) NOT ( (MH \\\"HIV\\\") OR (MH \\\"Acquired Immunodeficiency Syndrome\\\") OR aids OR \\\"HIV Infections\\\" OR hiv OR \\\"human immunodeficiency virus\\\" OR \\\"acquired immunodeficiency syndrome\\\" )\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e26 August 2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eScopus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e( TITLE-ABS-KEY ( sampling OR sample OR \\\"self sampling\\\" OR \\\"self sample\\\" OR \\\"sti testing\\\" OR \\\"sti diagnosis\\\" OR \\\"sexually transmitted infections test*\\\" OR \\\"self-collect*\\\" OR \\\"sexually transmitted disease testing*\\\" ) AND TITLE-ABS-KEY ( \\\"Specimen Handling\\\" ) AND TITLEABS-KEY ( \\\"Sexually Transmitted Disease*\\\" OR \\\"sexually transmitted infection*\\\" ) AND TITLE-ABS-KEY ( wom*n OR female* OR girl* ) AND NOT TITLE-ABS-KEY ( aids OR \\\"HIV Infections\\\" OR hiv OR \\\"human immunodeficiency virus\\\" OR \\\"acquired immunodeficiency syndrome\\\" ) )\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e26 August 2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCochrane\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(sampling OR sample OR \\\"self sampling\\\" OR \\\"self sample\\\" OR \\\"sti testing\\\" OR \\\"sti diagnosis\\\" OR \\\"sexually transmitted infections test*\\\" OR \\\"selfcollect*\\\" OR \\\"sexually transmitted disease testing*\\\"):ti,ab,kw (Word variations have been searched)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy selection\\u003c/h2\\u003e \\u003cp\\u003eScreening of studies suitable for inclusion in the systematic review and meta-analysis was conducted on the studies between 2015\\u0026ndash;2022. Since this systematic review stems from the findings of a scoping review which was conducted in 2021. Studies which had been screened for the scoping review from 2015\\u0026ndash;2021 were re-screened using eligibility criteria for the systematic review. To ensure the inclusion of studies conducted in 2022, the assisting librarian conducted a new search for studies that were published in 2022. An EndNote library was then created for all studies that were eligible for full-text screening. Thereafter, ZNJ and TD performed full-text screening of all studies that fulfilled the eligibility criteria of the systematic review and meta-analysis. NT resolved discrepancies that arose during full-text screening by ZNJ and TD. Thereafter, ZNJ and NT extracted data from studies found eligible for inclusion at the full-text screening stage. Thereafter, any disagreements were resolved by discussion until an agreement was reached. Study selection for the systematic review was guided by the PRISMA flowchart.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData extraction\\u003c/h2\\u003e \\u003cp\\u003eZNJ and NT independently extracted data from eligible studies using a data extraction tool that was designed to extract data from the included primary studies. The tool was piloted using 10% of the included studies and amended accordingly before final use. The extracted data was divided into two separate sections namely a section for basic qualitative information and another section for the quantitative outcomes of interest. Basic information extracted included author name(s) and year of publication, study title, study aims, study population, study design, sample size, eligibility criteria, reference standard specimen, type of self-collected specimen, type of laboratory assay, main findings, and conclusions. Data extracted for the section on the outcome of primary studies true positive, true negative, false positive, false negative, sensitivity and specificity, positive predictive value, negative predictive value, and evidence of agreement or concordance between self-collected and healthcare worker collected specimens. In some instances, the true negative, true positive false positive and false negative results were not available, and the relevant data was requested from the authors. A 2x2 table was produced based on the collected data. Any discrepancies that arose between the reviewers were discussed until a unanimous resolution was reached.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eAssessment of methodological quality\\u003c/h2\\u003e \\u003cp\\u003eThe Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for primary diagnostic accuracy studies, was utilised to assess the quality of all the included studies (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). This tool consists of four main domains that include patient selection, index test, reference standard, and flow and timing (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e), which were adapted to the current study accordingly. To determine the risk of bias, signalling questions answered as \\u0026ldquo;yes\\u0026rdquo; \\u0026ldquo;no\\u0026rdquo; or \\u0026ldquo;unclear\\u0026rdquo;, were used in each phase (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis and data synthesis\\u003c/h2\\u003e \\u003cp\\u003eFor included studies in which sensitivity and specificity had been assessed and reported a meta-analysis of diagnostic accuracy was performed. The Review Manager (RevMan) software was used to conduct statistical analysis. The RevMan software was also used to calculate the pooled sensitivity, specificity, and diagnostic odds ratio with a 95% confidence interval. Cochran\\u0026rsquo;s Q statistics were utilised to determine heterogeneity among the included primary studies. Statistical significance in all the analyses was calculated using the \\u003cem\\u003ep\\u003c/em\\u003e-value where a p-value of \\u0026lt;\\u0026thinsp;0.05 indicated statistical significance.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eStudy selection and characteristics of included studies\\u003c/h2\\u003e\\n \\u003cp\\u003eSixteen studies conducted in 2015, which were retrieved during a database search for the scoping review underwent title screening using the relevant eligibility criteria for the systematic review. For the new database search conducted by the librarian to ensure the inclusion of studies in Aug 2022, forty-eight search results were retrieved. Nine were duplicates, which left only thirty-nine eligible for title screening. The abstract screening was then conducted on fifty-five studies (thirty-nine plus sixteen studies). Post abstract screening, thirty-seven studies were excluded and only eighteen studies were eligible for data extraction. Reasons for exclusion were studies presenting data on pooled specimens, studies not presenting data on self-collected and healthcare worker collected specimens, and studies not about self-sampling STIs. Post full text screening of the studies only fourteen were eligible for inclusion in the systematic review. Four studies were excluded for being conducted before 2015, studies not about self-sampling, not about STIs, and a study presenting data on pooled specimens. Ultimately, data extraction was conducted on a total of fourteen studies (see Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e below). There was moderate agreement between the reviewers at full-text screening (\\u003cem\\u003ekappa\\u0026thinsp;=\\u0026thinsp;0.5\\u003c/em\\u003e).\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eCharacteristics of included studies\\u003c/h2\\u003e\\n \\u003cp\\u003eThe characteristics of included studies are all depicted in Table \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. Fourteen studies were included in the systematic review but not all of them were included in the meta-analysis. A large portion of the studies, five studies, were from the United States of America (USA) (\\u003cspan class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e), one study in Canada (\\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e), one in Haiti (\\u003cspan class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e), one in France (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e), one study in Saudi Arabia (\\u003cspan class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e), one in India (\\u003cspan class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e), one in the Republic of Korea (\\u003cspan class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e), one study in Kenya (\\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e), one in Chad (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e), one study in Ghana (\\u003cspan class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e). See Table \\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e for quantitative characteristics of included studies. It is important to note that some of the sensitivity and specificity measurements were obtained from the articles as calculated by the authors. However, where the measurements were not available, the researchers calculated using data that was already available on the manuscripts and original data obtained from authors of some of the included studies. Furthermore, for studies where this information was not available at all, it was not reported.\\u0026nbsp;\\u003c/p\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eCharacteristics of included studies\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDISEASE\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eSPECIMEN AND TESTING\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAuthor, year published\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCountry of study\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy design\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy population (sex) and samples size\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMode of instruction for self-collection\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLocation of self-collection\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSpecimen (healthcare worker collected/self-collected\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDiagnostic platform\\u003c/p\\u003e\\n \\u003cp\\u003eAutomated (run on instrument) / manual (manual method used)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAssay type\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eArias et al\\u003c/p\\u003e\\n \\u003cp\\u003e2016 (\\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCanada\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale \\u0026minus;\\u0026thinsp;189\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDemonstration of collection method and self-collection had collection instructions\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVaginal swab/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNAAT Aptima Combo 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCamus et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFrance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;1028\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInstructions provided.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVaginal/cervical classical sampling/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCOBAS \\u0026ndash; Roche Diagnostics Kits\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDe Marais et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClinical trial\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;193\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParticipants were instructed by a study nurse\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHome and clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ cervicovaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAptima Combo2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLockhart et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eKenya\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross-sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;350\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParticipants were\\u003c/p\\u003e\\n \\u003cp\\u003einstructed verbally\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ cervicovaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAptima combo assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNodjikouambaye et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChad\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross-sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;271\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTraining on specimen collection.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEndocervical swab/ veil sample\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMultiplex real-time PCR - Allplex STI Essential Assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVan Der Pol et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;3860\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNot indicated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNot indicated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVaginal swab/ vaginal swab, urine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNAAT - COBAS NG/CT test - the BD ProbeTec CT Qx and GC Qx amplified DNA assay; Aptima Combo 2 CT/NG; and the Abbott m2000 RealTime CT/NG assay.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHPV\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBoggan et al 2015 (\\u003cspan class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHaiti\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCohort\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;1836\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOrientation by a study nurse.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHybrid Capture 2 High-Risk HPV DNA Test\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDe Marais et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClinical trial\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;193\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParticipants were instructed by a study nurse\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHome and clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ cervicovaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAptima HPV assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eKim et al 2020 (\\u003cspan class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eKorea\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;151\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDigital and written instructions provided\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003emultiplex real-time PCR Anyplex II HPV28 Detection assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMcLarty et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;174\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eIndividual instructions were provided.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHome and study clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ tampon, vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRoche Cobas HPV method\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eObiri-Yeboah et al., 2017 (\\u003cspan class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eGhana\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;333\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInstructed on how to obtain a specimen\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ecareHPV assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMG\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCamus et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFrance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;1028\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInstructions provided.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVaginal/cervical classical sampling/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTIB MOLBIOL LightMix \\u0026ndash; PCR Roche Diagnostics\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDe Marais et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClinical trial\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;193\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParticipants were instructed by a study nurse\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHome and clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ cervicovaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAptima analyte-specific reagent-based assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLockhart et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eKenya\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross-sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;350\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParticipants were\\u003c/p\\u003e\\n \\u003cp\\u003einstructed verbally\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ cervicovaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAptima combo assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNodjikouambaye et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChad\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross-sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;271\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTraining on specimen collection.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEndocervical swab/ veil sample\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMultiplex real-time PCR - Allplex STI Essential Assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNG\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eArias et al\\u003c/p\\u003e\\n \\u003cp\\u003e2016 (\\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCanada\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;189\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDemonstration of collection method and self-collection had collection instructions\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVaginal swab/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNAAT Aptima Combo 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBarbee et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross-sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNot indicated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEndocervical swab/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eManual and automated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCulture and NAAT Aptima Combo 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCamus et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFrance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;1028\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInstructions provided.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVaginal/cervical classical sampling/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCOBAS \\u0026ndash; Roche Diagnostics Kits\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDe Marais et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClinical trial\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;193\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParticipants were instructed by a study nurse\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHome and clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ cervicovaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAptima Combo2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLockhart et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eKenya\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross-sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;350\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParticipants were\\u003c/p\\u003e\\n \\u003cp\\u003einstructed verbally\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ cervicovaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAptima combo assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNodjikouambaye et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChad\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross-sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;271\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTraining on specimen collection.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEndocervical swab/ veil sample\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMultiplex real-time PCR - Allplex STI Essential Assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVan Der Pol et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;3860\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNot indicated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNot indicated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVaginal swab/ vaginal swab, urine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNAAT - COBAS NG/CT test - the BD ProbeTec CT Qx and GC Qx amplified DNA assay; Aptima Combo 2 CT/NG; and the Abbott m2000 Real-Time CT/NG assay.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTV\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCamus et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFrance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;1028\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInstructions provided.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVaginal and cervical swabs/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTIB MOLBIOL LightMix \\u0026ndash; PCR Roche Diagnostics\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDe Marais et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClinical trial\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;193\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParticipants were instructed by a study nurse\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHome and clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ cervicovaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAptima TV assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHawash et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSaudi Arabia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;174\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInstructions were provided and sample collection was done in the presence of medical personnel.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVaginal swab/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eManual, and automated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOSOM TV rapid test, wet prep, TV DNA PCR\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eKhan et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eIndia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross-sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;550\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParticipants were given instructions\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVaginal swab/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eManual\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTrichomonas culture\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLockhart et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eKenya\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross-sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;350\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParticipants were\\u003c/p\\u003e\\n \\u003cp\\u003einstructed verbally\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ cervicovaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAptima combo assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNodjikouambaye et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChad\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross-sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;271\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTraining on specimen collection.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEndocervical swab/ veil sample\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAutomated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMultiplex real-time PCR - Allplex STI Essential Assay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSchwebke et al., 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCross sectional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u0026thinsp;=\\u0026thinsp;1867\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNot indicated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudy clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical swab/ vaginal swab\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eManual, and automated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eIn Pouch TV broth culture and Aptima NAAT for TV\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003cp\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eCT\\u0026thinsp;\\u003cem\\u003e=\\u0026thinsp;Chlamydia trachomatis;\\u003c/em\\u003e NG\\u0026thinsp;=\\u0026thinsp;\\u003cem\\u003eNeisseria gonorrhoea;\\u003c/em\\u003e TV\\u0026thinsp;=\\u0026thinsp;Trichomonas vaginalis; HPV\\u0026thinsp;=\\u0026thinsp;Human papillomavirus; DNA\\u0026thinsp;=\\u0026thinsp;Deoxyribonucleic acid; PCR\\u0026thinsp;=\\u0026thinsp;Polymerase Chain Reaction; Veil sample\\u0026thinsp;=\\u0026thinsp;self-collection device for cervicovaginal fluid collection.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003c/p\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eQuantitative characteristics of included studies\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDISEASE\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eHEALTHCARE WORKER VS SELF-COLLECTED\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eSELF-COLLECTED ONLY\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eHEALTHCARE WORKER COLLECTED ONLY\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAuthor, year published\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTP\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFP\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTN\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFN\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePPV (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNPV (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCohen\\u0026rsquo;s kappa/ concordance (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSensitivity (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSpecificity (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSensitivity (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSpecificity (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSensitivity (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSpecificity (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChlamydia trachomatis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eArias et al\\u003c/p\\u003e\\n \\u003cp\\u003e2016 (\\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e159\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e98.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e94.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCamus et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e994\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e97.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (NA)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.9 (99.7\\u0026ndash;100)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNodjikouambaye et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e126\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e92.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e97 (80.7\\u0026ndash;93.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e88 (80.7\\u0026ndash;93.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVan Der Pol et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e119\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1769\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e87.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.2 (95.4\\u0026ndash;99.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99 (99.4\\u0026ndash;99.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e98.6 (95.2\\u0026ndash;99.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.1 (98.6\\u0026ndash;99.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHuman papilloma virus\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDe Marais et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e) (HSIL)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (NA)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e88.9 (83.6\\u0026ndash;93.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (NA)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e90 (84.8\\u0026ndash;93.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDe Marais et al 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e) (CIN 2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (NA)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e91.1% (86\\u0026ndash;94.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (NA)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e92.2% (87.3\\u0026ndash;95.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eObiri-Yeboah et al., 2017 (\\u003cspan class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e94.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e92.6 (85.3\\u0026ndash;97.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e95.9 (89.8\\u0026ndash;98.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMycoplasma genitalium\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCamus et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1014\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (NA)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (NA)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNodjikouambaye et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e126\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e97 (80.7\\u0026ndash;93.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e88 (80.7\\u0026ndash;93.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNeisseria gonorrhoea\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eArias et al\\u003c/p\\u003e\\n \\u003cp\\u003e2016 (\\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e180\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e98.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e98.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCamus et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e85.7 (59.9\\u0026ndash;100)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (NA)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNodjikouambaye et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e126\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e86%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e97 (80.7\\u0026ndash;93.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e88 (80.7\\u0026ndash;93.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVan Der Pol et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1903\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e84.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (87.9\\u0026ndash;99.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.7 (99.3\\u0026ndash;99.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (87.9\\u0026ndash;100)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.7 (99,4\\u0026ndash;99.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTrichomoniasis vaginalis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCamus et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1015\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1015\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.88\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (NA)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.8 (99.5\\u0026ndash;100)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHawash et al 2021 (\\u003cspan class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e127\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e88.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e97.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e83.3 (58.5\\u0026ndash;96.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e98.4 (94.5\\u0026ndash;99.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e88.8 (65.2\\u0026ndash;98.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100 (97.1\\u0026ndash;100)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eKhan et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e547\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNodjikouambaye et al 2019 (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e126\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e92.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e97 (80.7\\u0026ndash;93.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e88 (80.7\\u0026ndash;93.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSchwebke et al., 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e) (InPouch)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e156\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1593\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e80.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e96.90 (92.9\\u0026ndash;99.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e97.70 (96.9\\u0026ndash;98.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSchwebke et al., 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e) (Aptima assay)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e186\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1593\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e96.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e97.4 (94.0\\u0026ndash;99.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.6 (99.1\\u0026ndash;99.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSchwebke et al., 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e) (PIS)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e186\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1591\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e96.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e96.4 (92.7\\u0026ndash;98.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.6 (99.1\\u0026ndash;99.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSchwebke et al., 2018 (\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e) (Xpert vs PIS)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e186\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1591\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e96.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e96.4 (92.7\\u0026ndash;98.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e99.6 (99.1\\u0026ndash;99.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"15\\\"\\u003e\\n \\u003cp\\u003eTP\\u0026thinsp;=\\u0026thinsp;True positive; FN\\u0026thinsp;=\\u0026thinsp;False positive; TN\\u0026thinsp;=\\u0026thinsp;True negative; FN\\u0026thinsp;=\\u0026thinsp;False negative; PPV\\u0026thinsp;=\\u0026thinsp;Positive predictive value; NPV\\u0026thinsp;=\\u0026thinsp;Negative predictive value; PIS\\u0026thinsp;=\\u0026thinsp;patient infected status\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003cp\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eThe characteristics of the included studies were further divided into sub-groups for meta-analysis for each STI as outlined in the following sections:\\u003c/p\\u003e\\n \\u003cp\\u003eChlamydia\\u003c/p\\u003e\\n \\u003cp\\u003eA total of six studies compared the diagnostic accuracy of self-collected specimens to healthcare worker collected specimens in females (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e). Five of the studies were conducted in a clinic (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e), and study location was not reported for one of the studies (\\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). Of these six studies, three of them compared healthcare worker collected vaginal swabs to self-collected vaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e). In two of the studies healthcare workers collected cervical swabs were compared to self-collected cervicovaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e). Only one study compared healthcare worker collected endocervical swabs to self-collected veil specimens (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). STI testing was performed using automated NAAT based assays. All six studies were cross-sectional studies. In five of the studies, research participants had received instructions on how to self-collect specimens for testing (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e), and in one study the research participants did not receive any instructions (\\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). The number of research participants in the studies ranged from 189 to 3860. Only four of the six studies were included in the subgroup meta-analysis (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e). Out of the two excluded studies, one study was excluded because only agreement data was reported and the other parameters were not reported (\\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e). Similarly, the other study only reported sensitivity and specificity data (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). Figure \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e presents research findings for the subgroup analysis of four studies, where the summary estimate for sensitivity was 0.85 (95% Confidence Interval 0.77\\u0026ndash;0.92), while specificity was 0.95 (95% Confidence Interval 0.91\\u0026ndash;0.98). The SROC plot (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e) is a depiction of the pooled sensitivity and specificity of the studies.\\u003c/p\\u003e\\n \\u003cp\\u003eThe studies show statistical significance in the studies, but there is moderate evidence of heterogeneity among the studies. The diagnostic tests have a good discriminatory ability to differentiate between individuals with and without chlamydia (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e below)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003c/p\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eHeterogeneity and statistical significance for CT\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eItem\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eResult\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.02. The result is significant at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCochran\\u0026rsquo;s Q (heterogeneity)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9.82\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDOR\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7.78\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003cp\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eHuman papilloma virus\\u003c/p\\u003e\\n \\u003cp\\u003eFive studies compared the diagnostic accuracy of healthcare worker collected specimens with self-collected specimens to diagnose HPV (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e). Three of the studies compared healthcare worker collected cervical swabs were compared to self-collected vaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e), while one study compared healthcare worker collected cervical swabs with self-collected tampons and vaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e), and another study compared healthcare worker collected cervical swab with self-collected cervicovaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). All the studies were conducted in a research clinic. The sample size of the studies ranged from 151 to 1836 study participants. Study participants received instructions on how to self-collect their specimens for STI diagnosis, prior to specimen collection. NAAT based diagnostic assays were used in all the studies. Four of the studies were cross-sectional studies (\\u003cspan class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e), and only one was a clinical trial (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). In one study, the sensitivity and specificity of self-collected specimens was 100% and 88.9% respectively, while healthcare worker collected diagnostic result sensitivity and specificity were 100% and 90% respectively (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). In another study, the sensitivity and specificity of self-collected specimens compared to healthcare worker collected specimens were 92.6% and 95.9% respectively(\\u003cspan class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e). One study reported the sensitivity of self-collected specimens as 100% (\\u003cspan class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e). Another study reported the sensitivity and specificity of only self-collected swab as 86% and 94% respectively, while for the self-collected tampon it was 77% and 100% respectively (\\u003cspan class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e). Another study reported sensitivity results of self-collected specimens as 89.1% and sensitivity of healthcare workers collected specimens as 87.9% (\\u003cspan class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). However, a sub-group meta-analysis was not performed because the relevant data for TN, FN, TP and FP was not available.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eMycoplasma genitalium\\u003c/h2\\u003e\\n \\u003cp\\u003eOut of the four studies that investigated MG infection, two studies compared self-collected cervicovaginal swabs with healthcare worker collected cervical swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e); one study compared healthcare worker collected vaginal and cervical swabs with self-collected vaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e), and another one compared healthcare worker collected endocervical swabs with self-collected veil specimens (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). Diagnostic testing was performed using NAAT based assays in all the studies. All the studies were conducted in clinics. In all the studies, research participants received instructions on how to self-collect specimens before collecting their own specimens. The sample size ranged from 193 to 1028 participants. All studies were cross-sectional. Only two of the included studies had sufficient data for a meta-analysis for this subgroup (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e). Figure \\u003cspan class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e presents the analysis of the two studies where the summary estimate for sensitivity was 0.49 (95% Confidence Interval 0.39\\u0026ndash;0.58) and for specificity was 0.88 (95% Confidence Interval 0.81\\u0026ndash;0.94).\\u003c/p\\u003e\\n \\u003cp\\u003ePresented below in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e is the SROC plot depicting the diagnostic accuracy of the studies in this subgroup.\\u003c/p\\u003e\\n \\u003cp\\u003eThe sub-group meta-analysis suggests that the accuracy of the diagnostic test may vary across studies, with poor sensitivity in one study and poor specificity in the other. However, overall, the test shows a moderate to high diagnostic accuracy, as indicated by the high DOR value (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eHeterogeneity and statistical significance for MG\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"2\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eItem\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eResult\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.001. The result is significant at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCochran\\u0026rsquo;s Q (heterogeneity)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e15.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDOR\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e21.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003eGonorrhoea\\u003c/p\\u003e\\n \\u003cp\\u003eSeven studies investigated the diagnostic accuracy of self-collected specimens in comparison to healthcare worker collected specimens in diagnosing NG. Six of these studies were cross-sectional (\\u003cspan class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e) (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e), and only one was a clinical trial (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). The sample size of the studies ranged from 89 to 3860. Laboratory diagnosis was performed using automated NAAT based assays in all the studies, and one of the studies also used manual diagnostic methods (\\u003cspan class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e). Six studies reported that specimen collection had occurred at research clinics (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e), and one study did not indicate (\\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). In six of the studies, research participants received instructions before specimen collection (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e), but in one study there was no report about whether research participants had been instructed how to self-collect their specimen (\\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). Two studies compared diagnostic accuracy in healthcare worker collected vaginal swabs to self-collected vaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e). One study compared self-collected vaginal swabs to cervical and vaginal swabs collected by healthcare workers (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e). Two studies compared diagnostic accuracy in self-collected cervicovaginal swabs and healthcare worker collected cervical swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e). In one study diagnostic accuracy is compared between healthcare worker collected endocervical swabs with self-collected vaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e). Another study compared diagnostic accuracy in self-collected veil specimens with healthcare worker collected endocervical swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). Figure \\u003cspan class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e below presents summary estimates for the sensitivity and specificity of diagnostic accuracy of healthcare worker collected specimens compared to self-collected specimens. The summary estimate for sensitivity and specificity is 0.59 (95% Confidence Interval 0.49\\u0026ndash;0.68) and 0.84 (95% Confidence Interval 0.76\\u0026ndash;0.91).\\u003c/p\\u003e\\n \\u003cp\\u003ePresented below in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e7\\u003c/span\\u003e is the SROC plot depicting the diagnostic accuracy of the studies in this subgroup.\\u003c/p\\u003e\\n \\u003cp\\u003eThe Cochran\\u0026apos;s Q test shows significant heterogeneity among the studies at 17.156. The diagnostic odds ratio of 2.579 suggests that the overall accuracy of the diagnostic test is low to moderate. The p-value indicates statistical significance. See Table \\u003cspan class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e below:\\u003c/p\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\u0026nbsp;\\u0026nbsp;\\u003ctable id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 6\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eHeterogeneity and statistical significance for NG\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eItem\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eResult\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.0006. The result is significant at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCochran\\u0026rsquo;s Q (heterogeneity)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e17.156\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDOR\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.579\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003cp\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eTrichomoniasis\\u003c/p\\u003e\\n \\u003cp\\u003eSeven studies investigated the diagnostic accuracy of self-collected specimens in comparison to healthcare worker collected specimens in diagnosing trichomoniasis. Six of the studies were cross-sectional (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e), and one study was a clinical trial (\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). Four studies utilised automated NAAT-based assays (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e), one study used manual testing methods (\\u003cspan class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e), while two studies used both automated NAAT assays and manual methods for TV diagnosis (\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e). Study participants in all the studies collected their specimens at the research clinics. In five of the studies the participants received instructions on how to self-collect specimens before collecting their specimens (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e), and in one study this was not reported (\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e). The sample size of research participants ranged from 174\\u0026ndash;1867. One study compared the diagnostic accuracy of healthcare worker collected vaginal and cervical swabs with self-collected swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e). Two studies compared healthcare worker collected cervical swabs with self-collected vaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e). One study compared endocervical swabs collected by healthcare workers with self-collected veil specimens (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). Two studies compared diagnostic accuracy between self-collected vaginal swabs with healthcare worker collected vaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e). Only one study compared healthcare worker collected endocervical swabs with self-collected vaginal swabs (\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). Figure \\u003cspan class=\\\"InternalRef\\\"\\u003e8\\u003c/span\\u003e below presents summary estimates for the sensitivity and specificity of diagnostic accuracy healthcare worker collected specimens compared to self-collected specimens.\\u003c/p\\u003e\\n \\u003cp\\u003eThe summary estimate for sensitivity and specificity is 0.94 (95% Confidence Interval 0.89\\u0026ndash;0.98) and 0.91 (95% Confidence Interval 0.85\\u0026ndash;0.96) respectively and it is depicted on the SROC in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e9\\u003c/span\\u003e below. Additionally, Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e9\\u003c/span\\u003e depicts the diagnostic accuracy of the studies in this subgroup.\\u003c/p\\u003e\\n \\u003cp\\u003eThe Cochran\\u0026apos;s Q test result shows that there is significant heterogeneity among the studies and the diagnostic test is moderately accurate in identifying patients with disease (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e7\\u003c/span\\u003e).\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab7\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 7\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eHeterogeneity and statistical significance for TV\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"2\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eItem\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eResult\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.001. The result is significant at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCochran\\u0026rsquo;s Q (heterogeneity)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e25.15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDOR\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e20.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable 8: QUADAS-2 Summary of methodological assessment\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\n \\u003c/div\\u003e\\n \\u003ctable style=\\\"width: 4.7e+2pt;margin-left:-22.95pt;border-collapse:collapse;border:none;\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 1.3in;border: 1pt solid windowtext;padding: 0in 5.4pt;height: 7.35pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;\\\"\\u003eStudy\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"4\\\" style=\\\"width: 211.2pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;height: 7.35pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;\\\"\\u003eRISK OF BIAS\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" style=\\\"width: 170.1pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 7.35pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;color:black;\\\"\\u003eAPPLICABILITY CONCERNS\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 7.35pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:6.0pt;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;\\\"\\u003ePATIENT SELECTION\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 7.35pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;\\\"\\u003eINDEX TEST\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 7.35pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;\\\"\\u003eREFERENCE STANDARD\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 7.35pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;\\\"\\u003eFLOW AND TIMING\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 7.35pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:6.0pt;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;color:black;\\\"\\u003ePATIENT SELECTION\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;\\\"\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 7.35pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;color:black;\\\"\\u003eINDEX TEST\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 7.35pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:12px;line-height:115%;color:black;\\\"\\u003eREFERENCE STANDARD\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eArias et al 2016\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eBarbee et al 2021\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eBoggan et al 2015\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eCamus et al 2021\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eDe Marais et al 2018\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eHawash et al 2021\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eLockhart et al 2018\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eKhan et al 2019\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eKim et al 2020\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eMcLarty et al 2019\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eNodjikouambaye et al 2019\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eObiri-Yeboah et al 2017\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eSchwebke et al 2017\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 1.3in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:13px;line-height:115%;\\\"\\u003eVan Der Pol et al 2019\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#FBD4B4;\\\"\\u003eL\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"font-size:19px;line-height:115%;font-family:Wingdings;color:black;background:#D6E3BC;\\\"\\u003eJ\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 55.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.1pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:11.0pt;font-family:\\\"Calibri\\\",sans-serif;text-align:center;line-height:115%;'\\u003e\\u003cspan style=\\\"line-height:115%;color:black;background:#B6DDE8;\\\"\\u003e\\u0026nbsp; ?\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eMethodological quality of studies\\u003c/h2\\u003e\\n \\u003cp\\u003eTable \\u003cspan class=\\\"InternalRef\\\"\\u003e8\\u003c/span\\u003e below depicts the risk of bias and applicability assessment of included studies using the QUADAS-2 tool used to assess quality (\\u003cspan class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). The domains of the QUADAS-2 tool are patient selection, index test, reference standard, and flow and timing. Patient selection outlines the process of selecting study participants in the primary studies which includes setting, presentation, prior testing, and intended use of index test; index test describes how the test of interest was conducted and interpreted; reference standard describes how the standard test was conducted and interpreted, and flow and timing describe excluded studies and intervals between the index and reference tests (\\u003cspan class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). For the current study, the index test is designated as the self-collected specimens, while the reference test refers to the healthcare worker collected specimens.\\u003c/p\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\u0026nbsp;For the majority of the studies, the sampling approach utilised was convenience sampling and not random or consecutive sampling which are the options available in the patient selection domain. Although convenience sampling was used for most of the studies and therefore introduced a high-risk bias, that is unlikely to interfere with the diagnostic accuracy of self-sampling and healthcare worker collected specimens. The reference standard domain and flow and timing domains were found to mostly be at low risk of bias in all the studies. Concerning applicability, all studies were at low risk of bias. However, regarding the applicability of the reference standard, it was unclear for most studies. The graphical results of the included studies from the QUADAS-2 quality assessment tool are indicated in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e10\\u003c/span\\u003e.\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis study compared the diagnostic accuracy of self-collected specimens to healthcare worker collected specimens for diagnosing CT, HPV, MG, NG, syphilis, and TV in females. No studies on syphilis fulfilled the eligibility criteria for inclusion in this review. For CT, six studies were included in the analysis, out of which four were included in the subgroup meta-analysis. The summary estimate for sensitivity was 0.85 (0.77\\u0026ndash;0.92), while specificity was 0.95 (0.91\\u0026ndash;0.98). For HPV, five studies were included, and there was insufficient data to perform a sub-group meta-analysis. However, the sensitivity and specificity of self-collected specimens of the individual studies compared to healthcare worker collected specimens varied between studies, with sensitivity ranging from 86\\u0026ndash;100%, and specificity ranging from 88.9\\u0026ndash;100%. For MG, four studies investigated diagnostic accuracy, and two studies had sufficient data for a sub-group meta-analysis. The summary estimate for sensitivity was low at 0.49 (0.39\\u0026ndash;0.58), while specificity was 0.88 (0.81\\u0026ndash;0.94). For NG, seven studies were included in the analysis, and four studies were included in the sub-group meta-analysis. The pooled sensitivity and specificity estimate was 0.59 (0.49\\u0026ndash;0.68) and 0.84 (0.76\\u0026ndash;0.91) respectively.\\u003c/p\\u003e \\u003cp\\u003eIn the case of CT and NG, it is important to note that the low sensitivity and high specificity are comparable to previous findings (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). For TV, seven studies investigated diagnostic accuracy, and four studies were included in the sub-group meta-analysis. The results of the meta-analysis showed that self-collected specimens have high sensitivity and specificity for the diagnosis of trichomoniasis, with a summary estimate for sensitivity and specificity of 0.94 (0.89\\u0026ndash;0.98) and 0.91 (0.85\\u0026ndash;0.96), respectively.\\u003c/p\\u003e \\u003cp\\u003eThe study found that there was significant heterogeneity among the studies. This may be attributed to differences in the methods used to collect and test specimens across the different studies. The DOR results indicated that the diagnostic tests used in the studies had a good ability to differentiate between individuals with and without CT, HPV, NG, MG and TV. The study also presented a SROC curve to visualize the sensitivity and specificity of all included studies, with most points falling between 0.9 and 1.00 on the y-axis (sensitivity), indicating better performance in distinguishing between the presence and absence of infection.\\u003c/p\\u003e \\u003cp\\u003eThe QUADAS-2 tool was used to assess the quality of the included studies, and it showed that a majority of them used convenience sampling to select patients. Although this sampling method can increase the risk of bias, it did not appear to affect the diagnostic accuracy of self-collected specimens and specimens collected by healthcare workers. Most of the included studies had a low risk of bias in the index test, reference standard, flow, and timing domains. Overall, the included studies introduced minimal bias, which enhances the quality of the research findings. Study screening, selection, and data extraction were conducted systematically to ensure the most suitable studies were included in the review. A comprehensive approach to reviewing existing evidence on the diagnostic accuracy of self-collected specimens versus those collected by healthcare workers was employed. Only peer-reviewed and published studies were included to ensure reliable results. Some of the included studies utilized convenience sampling, which may have introduced bias in the patient selection process.\\u003c/p\\u003e \\u003cp\\u003eSince we classified healthcare worker collected specimens as the gold-standard diagnostic accuracy was presumed to be 100%. For CT the healthcare worker collected sensitivity ranged between 50% and 100%, while specificity was 88% and 99.2%; for MG sensitivity ranged between 97% and 100%, while specificity was 88% and 100%; NG sensitivity ranged between 40% and 97%, while specificity was 88% and 100%; and TV sensitivity ranged between 96% and 100%, while specificity was 88% and 100%.\\u003c/p\\u003e \\u003cp\\u003eThe results indicate that self-collected specimens are a comparative alternative to healthcare worker collected specimens for STI testing. This is in keeping with previous studies that advocate for the use of self-sampling interventions as alternative tools to enable and promote screening of STIs even in asymptomatic patients and resource- limited settings (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e). These findings have important implications for STI testing, particularly in settings where access to healthcare workers may be limited or where stigma and embarrassment may prevent individuals from seeking testing.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThis study presents evidence of the accuracy of self-collected specimens when used to diagnose STIs in females. The meta-analysis findings highlight that the diagnostic accuracy of self-collected specimen to diagnose STIs in females is comparable with that of healthcare worker collected specimens. When considering the global burden of STIs on the public health system, such findings are an indication of how self-sampling for STI diagnosis could be used to improve STI management services across the globe. Although much evidence exists on the use of this intervention in high-income countries (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e), the researchers hope that the findings of this study will capture the attention of governments in LIMCs and cause them to see their need for it. Furthermore, the potential of self-sampling interventions to improve screening of asymptomatic STIs must be recognized and utilized as a tool to fulfil goal 3 of the sustainable development goals which is targeted at treating and improving access to quality healthcare for all people across the globe. The study is limited in that the investigation of diagnostic accuracy of self-collected specimens was only conducted on females. Therefore, the findings are not representative of self-collected specimens among a broader and more diverse population. We, therefore, recommend a future study to investigate the accuracy of self-collected specimens for diagnosing a wide range of STIs in a more diverse and broader population.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eCT: \\u003cem\\u003eChlamydia trachomatis\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCIN2: Cervical intraepithelial neoplasia 2\\u003c/p\\u003e\\n\\u003cp\\u003eDOR: Diagnostics Odds Ratio\\u003c/p\\u003e\\n\\u003cp\\u003eDoH SA: Department of Health South Africa\\u003c/p\\u003e\\n\\u003cp\\u003eFP: False positive\\u003c/p\\u003e\\n\\u003cp\\u003eFN: False negative\\u003c/p\\u003e\\n\\u003cp\\u003eHPV: Human papilloma virus\\u003c/p\\u003e\\n\\u003cp\\u003eHSIL: High grade squamous intraepithelial lesion\\u003c/p\\u003e\\n\\u003cp\\u003eLMICs: Low-and-middle-income countries\\u003c/p\\u003e\\n\\u003cp\\u003eMeSH: Medical Subject Headings\\u003c/p\\u003e\\n\\u003cp\\u003eMG: \\u003cem\\u003eMycoplasma genitalium\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNAAT: Nucleic acid amplification test\\u003c/p\\u003e\\n\\u003cp\\u003eNG: \\u003cem\\u003eNeisseria gonorrhoea\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNPV: Negative predictive value\\u003c/p\\u003e\\n\\u003cp\\u003ePCR: Polymerase chain reaction\\u003c/p\\u003e\\n\\u003cp\\u003ePI: Principal investigator\\u003c/p\\u003e\\n\\u003cp\\u003ePIS: \\u0026nbsp;Patient infected status\\u003c/p\\u003e\\n\\u003cp\\u003ePICO: Population Intervention Comparison Outcome\\u003c/p\\u003e\\n\\u003cp\\u003ePPV: Positive predictive value\\u003c/p\\u003e\\n\\u003cp\\u003ePRISMA: Preferred Reporting Items for Systematic Review and Meta-analyses\\u003c/p\\u003e\\n\\u003cp\\u003eQUADAS-2: Quality Assessment of Diagnostic Accuracy Studies 2\\u003c/p\\u003e\\n\\u003cp\\u003eRevMan: Review manager\\u003c/p\\u003e\\n\\u003cp\\u003eSTI: Sexually transmitted infections\\u003c/p\\u003e\\n\\u003cp\\u003eSROC: Summary receiver operating characteristic\\u003c/p\\u003e\\n\\u003cp\\u003eTN: True negative\\u003c/p\\u003e\\n\\u003cp\\u003eTP: True positive\\u003c/p\\u003e\\n\\u003cp\\u003eTV: Trichomonas vaginalis\\u003c/p\\u003e\\n\\u003cp\\u003eWHO: World Health Organization\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate:\\u0026nbsp;\\u003c/strong\\u003eEthical clearance for the study was obtained from the University of Pretoria\\u0026rsquo;s Faculty of Health Sciences Research Ethics Committee. The reference number is 136/2022. Participant consent was not applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials:\\u0026nbsp;\\u003c/strong\\u003eAll data generated or analysed during this study are included in this manuscript [and its supplementary information files].\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u0026nbsp;\\u003c/strong\\u003eThere are no competing interests\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u0026nbsp;\\u003c/strong\\u003eNo funding was received from any funding agencies in public, commercial, or non-profit sectors\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions:\\u003c/strong\\u003e Conceptualization, Z.N.J. and T.M.-T.; developing and conducting the search strategy, K.K; screening, Z.N.J., T.D., and NT.; writing - original draft, Z.N.J.; writing\\u0026mdash;reviewing and editing, T.M.-T., W.M., T.Dz.; supervision, T.M.-T and W.M. All authors have read and agreed to the current version of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements:\\u0026nbsp;\\u003c/strong\\u003eThe authors wish to thank the University of Pretoria and Mangosuthu University of Technology for providing all the necessary resources for developing this review.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eOrganization WH. Report on global sexually transmitted infection surveillance 2018. 2018.\\u003c/li\\u003e\\n\\u003cli\\u003eVan Gerwen OT, Muzny CA, Marrazzo JM. Sexually transmitted infections and female reproductive health. Nature Microbiology. 2022;7(8):1116-26.\\u003c/li\\u003e\\n\\u003cli\\u003eOrganization WH. Sexually transmitted infections: implementing the global STI strategy. World Health Organization; 2017.\\u003c/li\\u003e\\n\\u003cli\\u003eWHO. Sexually transmitted infections (STIs): key facts. 2016.\\u003c/li\\u003e\\n\\u003cli\\u003eNewman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PloS one. 2015;10(12):e0143304.\\u003c/li\\u003e\\n\\u003cli\\u003eOrganization WH. Sexually transmitted infections (STIs): the importance of a renewed commitment to STI prevention and control in achieving global sexual and reproductive health. World Health Organization; 2013.\\u003c/li\\u003e\\n\\u003cli\\u003eR\\u0026oslash;ttingen J-A, Cameron DW, Garnett GP. A Systematic Review of the Epidemiologie Interactions Between Classic Sexually Transmitted Diseases and HIV: How Much Really Is Known? Sexually transmitted diseases. 2001:579-97.\\u003c/li\\u003e\\n\\u003cli\\u003eGarrett NJ, McGrath N, Mindel A. Advancing STI care in low/middle-income countries: has STI syndromic management reached its use-by date? : BMJ Publishing Group Ltd; 2017. p. 4-5.\\u003c/li\\u003e\\n\\u003cli\\u003eOrganization WH. Guidelines for the management of symptomatic sexually transmitted infections: World Health Organization; 2021.\\u003c/li\\u003e\\n\\u003cli\\u003eOrganization WH. Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus World Health Organisation; 2013. Contract No.: World Health Organisation.\\u003c/li\\u003e\\n\\u003cli\\u003ePaudyal P, Llewellyn C, Lau J, Mahmud M, Smith H. Obtaining self-samples to diagnose curable sexually transmitted infections: a systematic review of patients\\u0026rsquo; experiences. PloS one. 2015;10(4):e0124310.\\u003c/li\\u003e\\n\\u003cli\\u003eGarrett NJ, Osman F, Maharaj B, Naicker N, Gibbs A, Norman E, et al. Beyond syndromic management: opportunities for diagnosis-based treatment of sexually transmitted infections in low-and middle-income countries. PloS one. 2018;13(4):e0196209.\\u003c/li\\u003e\\n\\u003cli\\u003eChauhan V, Shah MC, Patel SV, Marfatia YS, Zalavadiya D. Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. Indian Journal of Sexually Transmitted Diseases and AIDS. 2016;37(1):28.\\u003c/li\\u003e\\n\\u003cli\\u003eMurewanhema G, Moyo E, Mhango M, Chitungo I, Moyo P, Musuka G, et al. Abnormal vaginal discharge among women of reproductive age in sub-Saharan Africa: the need for a paradigm shift from a syndromic approach to specific pathogen identification and directed treatment. IJID Regions. 2022;5:165-8.\\u003c/li\\u003e\\n\\u003cli\\u003eLunny C, Taylor D, Hoang L, Wong T, Gilbert M, Lester R, et al. Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis. PLoS One. 2015;10(7):e0132776.\\u003c/li\\u003e\\n\\u003cli\\u003eGarland SM, Tabrizi SN. Diagnosis of sexually transmitted infections (STI) using self-collected non-invasive specimens. Sexual health. 2004;1(2):121-6.\\u003c/li\\u003e\\n\\u003cli\\u003eGriner SB, Beckstead JW, Vamos CA, Puccio JA, Perrin K, Daley EM. Characteristics associated with the adoption of consumer-based self-sampling methods for sexually transmitted infection screening. Journal of American College Health. 2022:1-8.\\u003c/li\\u003e\\n\\u003cli\\u003eHarding-Esch EM, Hollis E, Mohammed H, Saunders JM. Self-sampling and self-testing for STIs and HIV: the case for consistent nomenclature. Sexually transmitted infections. 2016.\\u003c/li\\u003e\\n\\u003cli\\u003eNodjikouambaye ZA, Compain F, Sadjoli D, Mboumba Bouassa R-S, P\\u0026eacute;r\\u0026eacute; H, Veyer D, et al. Accuracy of curable sexually transmitted infections and genital mycoplasmas screening by multiplex real-time PCR using a self-collected veil among adult women in Sub-Saharan Africa. Infectious diseases in obstetrics and gynecology. 2019;2019.\\u003c/li\\u003e\\n\\u003cli\\u003eW\\u0026uuml;rstle S, Spinner CD, Voit F, Hoffmann D, Hering S, Weidlich S, et al. Self-sampling versus health care professional-guided swab collection for SARS-CoV-2 testing. Infection. 2021;49(5):927-34.\\u003c/li\\u003e\\n\\u003cli\\u003eOgale Y, Yeh PT, Kennedy CE, Toskin I, Narasimhan M. Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ global health. 2019;4(2):e001349.\\u003c/li\\u003e\\n\\u003cli\\u003eJaya ZN, Mapanga W, van Niekerk B, Dlangalala T, Kgarosi K, Dzobo M, et al. Mapping Evidence of Self-Sampling to Diagnose Sexually Transmitted Infections in Women: A Scoping Review. Diagnostics. 2022;12(8):1803.\\u003c/li\\u003e\\n\\u003cli\\u003eOgilvie G, Patrick D, Schulzer M, Sellors J, Petric M, Chambers K, et al. Diagnostic accuracy of self collected vaginal specimens for human papillomavirus compared to clinician collected human papillomavirus specimens: a meta-analysis. Sexually transmitted infections. 2005;81(3):207-12.\\u003c/li\\u003e\\n\\u003cli\\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery. 2021;88:105906.\\u003c/li\\u003e\\n\\u003cli\\u003eWhiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529-36.\\u003c/li\\u003e\\n\\u003cli\\u003eBarbee LA, Golden MR, Thibault CS, McNeil CJ, Soge OO. Performance of patient-collected specimens for Neisseria gonorrhoeae culture. Clinical Infectious Diseases. 2021;73(9):e3196-e200.\\u003c/li\\u003e\\n\\u003cli\\u003eDes Marais AC, Zhao Y, Hobbs MM, Barclay L, Brewer NT, Smith JS. Home self-collection by mail to test for human papillomavirus and sexually transmitted infections. Obstetrics and gynecology. 2018;132(6):1412.\\u003c/li\\u003e\\n\\u003cli\\u003eMcLarty JW, Williams DL, Loyd S, Hagensee ME. Cervical Human Papillomavirus Testing With Two Home Self-Collection Methods Compared With a Standard Clinically Collected Sampling Method. Sexually Transmitted Diseases. 2019;46(10):670-5.\\u003c/li\\u003e\\n\\u003cli\\u003eSchwebke JR, Gaydos C, Davis T, Marrazzo J, Furgerson D, Taylor S, et al. Clinical evaluation of the Cepheid Xpert TV assay for detection of Trichomonas vaginalis with prospectively collected specimens from men and women. Journal of clinical microbiology. 2018;56(2):e01091-17.\\u003c/li\\u003e\\n\\u003cli\\u003eVan Der Pol B, Fife K, Taylor SN, Nye MB, Chavoustie SE, Eisenberg DL, et al. Evaluation of the performance of the cobas CT/NG test for use on the cobas 6800/8800 systems for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male and female urogenital samples. Journal of clinical microbiology. 2019;57(4):e01996-18.\\u003c/li\\u003e\\n\\u003cli\\u003eArias M, Dan J, Gilchrist J, Luinstra K, Li J, Smieja M, et al. Ease, comfort, and performance of the HerSwab vaginal self-sampling device for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae. Sexually Transmitted Diseases. 2016;43(2):125-9.\\u003c/li\\u003e\\n\\u003cli\\u003eBoggan JC, Walmer DK, Henderson G, Chakhtoura N, McCarthy SH, Beauvais HJ, et al. Vaginal self-sampling for HPV infection as a primary cervical cancer screening tool in a Haitian population. Sexually transmitted diseases. 2015;42(11):655.\\u003c/li\\u003e\\n\\u003cli\\u003eCamus C, Penaranda G, Khiri H, Camiade S, Molet L, Lebsir M, et al. Acceptability and efficacy of vaginal self-sampling for genital infection and bacterial vaginosis: A cross-sectional study. PloS one. 2021;16(11):e0260021.\\u003c/li\\u003e\\n\\u003cli\\u003eHawash Y, Jaafer N, Alpakistany T. Ease of use and validity testing of a point-of-care fast test for parasitic vaginosis self-diagnosis. Tropical Biomedicine. 2021;38(4):491-8.\\u003c/li\\u003e\\n\\u003cli\\u003eKhan Z, Bhargava A, Mittal P, Bharti R, Puri P, Khunger N, et al. Evaluation of reliability of self-collected vaginal swabs over physician-collected samples for diagnosis of bacterial vaginosis, candidiasis and trichomoniasis, in a resource-limited setting: a cross-sectional study in India. BMJ open. 2019;9(8):e025013.\\u003c/li\\u003e\\n\\u003cli\\u003eKim MH, Jung HJ, Park SI, Kim BJ. Self‐obtained vaginal samples for HPV DNA testing to detect HPV‐related cervical disease. International Journal of Gynecology \\u0026amp; Obstetrics. 2021;154(1):127-32.\\u003c/li\\u003e\\n\\u003cli\\u003eLockhart A, Psioda M, Ting J, Campbell S, Mugo N, Kwatampora J, et al. Prospective evaluation of cervicovaginal self-and cervical physician collection for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium infections. Sexually transmitted diseases. 2018;45(7):488.\\u003c/li\\u003e\\n\\u003cli\\u003eObiri-Yeboah D, Adu-Sarkodie Y, Djigma F, Hayfron-Benjamin A, Abdul L, Simpore J, et al. Self-collected vaginal sampling for the detection of genital human papillomavirus (HPV) using careHPV among Ghanaian women. BMC women\\u0026apos;s health. 2017;17(1):1-6.\\u003c/li\\u003e\\n\\u003cli\\u003eNi Y, Lu Y, He X, Li Y, Li Y, Guo S, et al. Self-sampled specimens demonstrate comparable accuracy and consistency to clinician-sampled specimens for HPV detection among men who have sex with men in China. Sexually Transmitted Infections. 2022.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"scientific-reports\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"scirep\",\"sideBox\":\"Learn more about [Scientific Reports](http://www.nature.com/srep/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"Scientific Reports\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Scientific Reports\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"self-collect, sexually transmitted infections, diagnostic specimens, females, women\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3909356/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3909356/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eThe use of self-collected specimens as an alternative to healthcare worker-collected specimens for diagnostic testing has gained increasing attention in recent years. This systematic review aimed to assess the diagnostic accuracy of self-collected specimens compared to healthcare worker-collected specimens across different sexually transmitted infections (STIs) including chlamydia, human papillomavirus (HPV), \\u003cem\\u003eMycoplasma genitalium\\u003c/em\\u003e (MG), gonorrhoea, syphilis and trichomoniasis in females. A rigorous process was followed to screen for studies in various electronic databases. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. There were no studies on syphilis that met the criteria for inclusion in the review. A total of six studies for chlamydia, five studies for HPV, four studies for MG, and seven studies for gonorrhoea and trichomoniasis were included in the review. However, not all studies were included in the sub-group meta-analysis. The analysis revealed that self-collected specimens demonstrated comparable diagnostic accuracy to healthcare worker-collected specimens across most STIs. This indicates that the diagnostic accuracy of self-collected specimens can provide accurate results and enhance access to diagnostic testing, potentially improving healthcare service delivery. Future research should further explore the diagnostic accuracy of self-collected specimens in larger and more diverse populations.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Accuracy of self-collected versus healthcare worker collected specimens for diagnosing sexually transmitted infections: an updated systematic review and meta-analysis\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-02-23 07:44:30\",\"doi\":\"10.21203/rs.3.rs-3909356/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-04-25T04:53:32+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-04-08T19:34:39+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"c714f853-583c-4176-90df-7211397fafe9\",\"date\":\"2024-03-29T17:54:29+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-03-18T21:54:24+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"bf96e499-1d37-4a61-8260-9371a0c071a8\",\"date\":\"2024-03-04T17:05:24+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2024-02-24T17:47:25+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-02-24T17:43:19+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2024-02-21T12:00:03+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-02-21T11:54:30+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Scientific Reports\",\"date\":\"2024-01-29T18:46:25+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"scientific-reports\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"scirep\",\"sideBox\":\"Learn more about [Scientific Reports](http://www.nature.com/srep/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"Scientific Reports\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Scientific Reports\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"69b28cd1-fc61-456b-ba1b-7f43d52ef1fe\",\"owner\":[],\"postedDate\":\"February 23rd, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-05-14T21:30:01+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-3909356\",\"link\":\"https://doi.org/10.1038/s41598-024-61358-y\",\"journal\":{\"identity\":\"scientific-reports\",\"isVorOnly\":false,\"title\":\"Scientific Reports\"},\"publishedOn\":\"2024-05-07 21:18:11\",\"publishedOnDateReadable\":\"May 7th, 2024\"},\"versionCreatedAt\":\"2024-02-23 07:44:30\",\"video\":\"\",\"vorDoi\":\"10.1038/s41598-024-61358-y\",\"vorDoiUrl\":\"https://doi.org/10.1038/s41598-024-61358-y\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-3909356\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-3909356\",\"identity\":\"rs-3909356\",\"version\":[\"v1\"]},\"buildId\":\"veTbxFhMMB0_faC6-Wkog\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}