Background. Testing and subsequent treatment is an important strategy to improve clinical outcomes and reduce and HIV and sexually transmitted infections (STI) transmission in high-risk groups, such as men who have sex with men (MSM). Home-based sexual health care could reduce barriers for testing and therefore has the potential to reach MSM who do not (regularly) test, younger MSM and MSM who also have sex with men. We developed and implemented home-based sexual health care (Limburg4Zero), and this study aims to systematically evaluate the implementation process.
Methods. Our Dutch Centre of Sexual Health has recently implemented home-based sexual health care, including self-sampling STI/HIV tests for HIV-negative MSM, who do not use PrEP. Following the RE-AIM framework, we assessed (R) proportion reached population, (E) impact on aimed key populations, (A) adoption by health care providers, (I) degree of fidelity, and (M) possibility to institutionalise the intervention. This mixed-methods study design presents preliminary results from sexual history questionnaires of the first 362 participants and, in-depth interviews with 10 health care providers.
Results. By December 2022, 362 participants received a self-sampling test (return rate 64.1%) and additional sexual health information. Participants who received a self-sampling test had a median age of 30 and were mostly high educated (57.5%). Of participants 43.9% never tested for HIV before, 37.5% do not test every 6 months. Other subgroups that were more represented than clinic-visiting MSM, included those living in less urban areas (52.2%), MSM who also have sex with women (32.6%) and younger MSM (26.7%). Needs assessments among care providers revealed importance of co-creation with healthcare providers, community, researchers. Adoption was highly acceptable due to expected extended reach of MSM and fidelity in implementation was high (with several co-created adjustments). Infrastructural boundaries were mentioned as hurdle to maintain the implementation.
Conclusion. Implementing a home-based sexual health care in Limburg4zero has reached at-risk MSM subgroups, such as those who have never tested before. Health care providers assess home-based sexual health care, when done in co-creation, as acceptable for implementation in existing care structures. Therefore, this should be considered a necessary addition to regular clinic-based sexual health care.
