We will test for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) using a self-collected vaginal swab at baseline and again at months 6, 12, and 24. Self-collected swabs will be shipped monthly to the National Institute for Communicable Diseases (NICD; Johannesburg, South Africa) for nucleic acid amplification testing (NAAT) using the Aptima Combo 2® Assay (Hologic, San Diego, USA) for Neisseria gonorrhoeae and Chlamydia trachomatis and using the Aptima® Trichomonas vaginalis Assay (Hologic, San Diego, USA) for Trichomonas vaginalis. Negative test results will be notified at the next study visit. Positive test results will be notified immediately upon result availability via site-based visits or phone calls. Those with a positive STI test result will be provided a copy of their results and a treatment referral letter per South African STI guidelines [58].

Syphilis testing will be conducted during the enrolment visit only, using the Alere Determine™ Syphilis TP rapid test. Negative tests will be reported by the study nurse to participants; patients testing positive will be referred for further laboratory confirmatory testing and treatment as indicated. All enrolled participants will be tested for Hepatitis B antigen (HBsAg), performed by the National Health Laboratory Service. Participants with a negative test result will be provided hepatitis B vaccination per the South African vaccination schedule [59]; those that test positive will be asked to provide blood for ALT and AST testing to determine liver function and referred for care and treatment. Neither the syphilis nor hepatitis B test results will impact study eligibility.

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