Lowering the barriers to sexual health services: Impacts of free counselling and testing for sexually transmitted infections in Switzerland – an observational study

Background In Switzerland, tests for HIV and sexually transmitted infections (STI) are usually not covered by health insurance in asymptomatic people. To improve access, Zurich launched free voluntary counselling and testing (VCT) in June 2023 for residents <26 years or with low income. This study describes the implementation of free VCT for HIV and STIs in a high-income setting where access to testing was previously expensive, along with key barriers and enablers to accessing testing and counselling in the target population.

We conducted a study using routine health data, and a client feedback questionnaire (FBQ) collected during the first 12 months of the programme. Logistic regression models were used to assess factors associated with first-time HIV or STI testing, with results reported as odds ratios (ORs) and 95% confidence intervals (CIs).

In the first year, 3,475 people came for free testing. 83% (n=2,866) agreed to share their data. 21% (n=719) completed the FBQ. Median (IQR) age of participants was 24 (23, 26) years. 46% were assigned female at birth. Four HIV diagnoses were confirmed, all of them in MSM. The infection with the highest positivity rate was chlamydia (4.5%), followed by gonorrhoea (2.5%). Men having sex with men (MSM) showed the highest positivity rate in all STIs. 39% of visits were by individuals who had not received prior HIV testing. MSM, were significantly less likely to be first-time testers for HIV (OR: 0.28, 95% CI: 0.15– 0.48) and STI (OR: 0.74, 95% CI: 0.44–1.21) compared to women who have sex with men (WSM).

The free VCT project experienced high demand during the first year. Even in a high-income setting, counselling improved participants’ sexual health knowledge and facilitated many first HIV/STI tests. Competing Interest Statement I have read the journal's policy and the authors of this manuscript have the following competing interests: B.H. reports honoraria for advisory boards, lectures and travel grants paid to himself from the companies Gilead, MSD and ViiV, which are unrelated to the submitted work. J.S.F. reports grants for the institution from Gilead, MSD, and ViiV Healthcare, which are unrelated to the submitted work. The other authors declare no competing interests. Clinical Trial Main: BASEC register number: Req-2023-00594 SwissPrEPared study: (lead committee: Zurich, Switzerland-BASEC registration number: 2018-02015) ClinicalTrials.gov (NCT03893188) Funding Statement Yes Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: In accordance with the declaration of Helsinki, the evaluation of the pilot project has been exempted from ethical approval under the Swiss Human Research Act (HFG) by the Cantonal Ethics Committee of Zurich (BASEC register number: Req-2023-00594) as data were collected anonymously. Ethical approval for the SwissPrEPared study was received by all relevant local ethics committees (lead committee: Zurich, Switzerland—BASEC registration number: 2018–02015) on 15 May 2019 and was registered with ClinicalTrials.gov (NCT03893188) on 14 March 2019. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Datasets analysed during the current study and used to generate tables, figures, and the supplementary material are not publicly available due to the sensitive nature of the data yielded by this highly representative, individual-level dataset. Source data are thus not provided with this paper. Investigators with a request for selected data should send a proposal to the SwissPrEPared e-mail address (info{at}swissprepared.ch). The provision of data will be considered by the Scientific Board of the SwissPrEPared cohort study and the relevant study team. Data provision is subject to Swiss legal and ethical regulations and will be detailed in a material and data transfer agreement.