Access to sanitation is a universal right 1,2 ; however, insufficient access continues to persist globally, and we are not on track to meet the 2030 Sustainable Development Goal 3 targets to achieve universal sanitation coverage and halve the proportion of untreated wastewater . Even in regions reporting high sanitation access and treatment, national coverage averages can mask subnational disparities, often with lower access and treatment in marginalized and hard-to-reach communities . Conventional centralized wastewater treatment with underground collection systems and sewered toilets can be a mechanism to increase access to sanitation and the proportion of treated wastewater; however, many cities often have low sewerage connection rates , with low and lower-middle income populations averaging 11.7% and 17.6% sewerage coverage in 2022, respectively . Increasing sewer coverage requires large capital investments and significant maintenance of expansive pipeline networks -resources that are often out of reach for low and middle income countries . In the absence of sewer connections, many communities in low and lower-middle income countries rely on onsite bodily waste collection and storage via pit latrines or partial treatment onsite via septic tanks, the latter of which serves 7.6% (low income) and 31.8% (lower-middle income) of country populations . Although these conventional onsite wastewater treatment alternatives support sanitation access, they often leave wastewater partially or entirely untreated ; as of 2022, 75.6% and 52.5% of the low and lowermiddle income populations remain without access to safely managed sanitation, respectively .