The Central Valley is home to nearly 6.5 million people, and it is the most underserved patient population in California. The need for core services such as comprehensive healthcare is higher than ever, given that twenty-five percent live in poverty, and over fifty percent are Medicaid or uninsured. Currently, there are 133 active physicians per 100,000 people in the Central Valley in comparison with the California state rate of 222 active physicians per 100,000 people. Within the next ten years, California is expected to have a shortfall of up to 4,100 primary-care clinicians.

There are approximately 2000 mobile clinics nationwide assisting 6,000,000 people annually. In addition, mobile clinics are viewed as serving those with a barrier to health care. Nationwide, fifty-three percent of low-income adults don’t trust the health care system, twenty-five percent lack transportation, twenty percent go without care due to inability to pay, and eleven percent are uninsured.

-Neisseria gonorrhaeae (NG) and Chlamydia trachomatis (CT) are the two most common sexually transmitted infections (STIs) in the United States and increasing steadily with over 500,000 and 1.7 million cases in 2018, respectively.

-Standard of care for NG/CT diagnosis is testing with a nucleic acid amplification test (NAAT) and sample collection via provider-performed endocervical sampling (PPES).

-PPES can add significant delay in a busy emergency department (ED) setting in which exam room and/or provider availability is limited.

-Prior research in non-emergency department settings on self-obtained vaginal swabs (SOVS), where the patient collects their own vaginal sample using the NAAT swab, has shown favorable results. However, another study has shown a patient preference for PPES over VSS.

-If VSS was found to have noninferior sensitivity compared to PPES in the ED, with good patient acceptability, this would allow for earlier collection of samples and another diagnostic option for patients where a pelvic exam cannot be performed.