{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T23:31:44Z","timestamp":1785367904740,"version":"3.55.0"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"City of Zurich","award":["City Council Resolution GR Nr. 2021\/432"],"award-info":[{"award-number":["City Council Resolution GR Nr. 2021\/432"]}]},{"DOI":"10.13039\/501100002329","name":"Bundesamt f\u00fcr Gesundheit","doi-asserted-by":"publisher","award":["SwissPrEPared program"],"award-info":[{"award-number":["SwissPrEPared program"]}],"id":[{"id":"10.13039\/501100002329","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Switzerland, tests for HIV and sexually transmitted infections (STIs) 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 &lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the first year, 3,475 people came for free testing. 83% (n\u2009=\u20092,866) agreed to share their data. 21% (n\u2009=\u2009719) 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\u20130.48) and also less likely to be first-time testers for STIs (OR: 0.74, 95% CI: 0.44\u20131.21) compared to women who have sex with men (WSM); however, the latter association was non-significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The free VCT project experienced high demand during the first year. Even in a high-income setting, counselling improved participants\u2019 sexual health knowledge and facilitated many first HIV\/STI tests.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0327114","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:28:53Z","timestamp":1775064533000},"page":"e0327114","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Lowering the barriers to sexual health services: Impacts of free counselling and testing for sexually transmitted infections in Switzerland \u2013 an observational study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8849-3190","authenticated-orcid":true,"given":"Leonie","family":"Arns-Glaser","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Farnham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Hochstrasser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan S.","family":"Fehr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Hampel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"pone.0327114.ref001","doi-asserted-by":"crossref","first-page":"100742","DOI":"10.1016\/j.lanepe.2023.100742","article-title":"Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe","volume":"34","author":"O Mitj\u00e0","year":"2023","journal-title":"Lancet Reg Health Eur"},{"key":"pone.0327114.ref002","volume-title":"Sexuell \u00fcbertragene Infektionen und Hepatitis B\/C in der Schweiz und Liechtenstein im Jahr 2023: eine epidemiologische Beurteilung","author":"Federal Office of Public Health (FOPH)","year":"2024"},{"key":"pone.0327114.ref003","volume-title":"Sexuell \u00fcbertragene Infektionen und Hepatitis B\/C in der Schweiz und Liechtenstein im Jahr 2024: eine epidemiologische Beurteilung","author":"Federal Office of Public Health (FOPH)","year":"2025"},{"key":"pone.0327114.ref004","unstructured":"Federal Office of Public Health (FOPH). National programme (NAPS): Stop HIV, hepatitis B and C viruses and sexually transmitted infections. https:\/\/www.bag.admin.ch\/bag\/en\/home\/strategie-und-politik\/nationale-gesundheitsstrategien\/nationales-programm-hiv-hep-sti-naps.html. 2024. Accessed 2024 November 22."},{"issue":"1","key":"pone.0327114.ref005","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/hiv.13152","article-title":"Decrease of condom use in heterosexual couples and its impact on pregnancy rates: the Swiss HIV Cohort Study (SHCS)","volume":"23","author":"A Hachfeld","year":"2022","journal-title":"HIV Med"},{"issue":"2","key":"pone.0327114.ref006","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1080\/13625187.2018.1458226","article-title":"Is there a need for better sexual education of young men? Sexual behaviour and reproductive health in Swiss university students: a questionnaire-based pilot study","volume":"23","author":"GS Merki-Feld","year":"2018","journal-title":"Eur J Contracept Reprod Health Care"},{"issue":"9224","key":"pone.0327114.ref007","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/S0140-6736(00)02447-8","article-title":"Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania","volume":"356","author":"M Sweat","year":"2000","journal-title":"Lancet"},{"issue":"9","key":"pone.0327114.ref008","article-title":"Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries","volume":"2012","author":"VA Fonner","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0327114.ref009","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1186\/s12879-021-06498-6","article-title":"Integration of community-based testing data into national HIV surveillance in Poland, Serbia and Slovakia within the framework of INTEGRATE project","volume":"21","author":"L Fern\u00e0ndez-L\u00f3pez","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"5","key":"pone.0327114.ref010","doi-asserted-by":"crossref","first-page":"132","DOI":"10.59573\/emsj.7(5).2023.12","article-title":"Self Esteem, Anxiety and Gender as Predictors of Attitude towards Voluntary Counselling and Testing of HIV\/AIDS among Nigeria Undergraduates","volume":"7","author":"CN Udeze","year":"2023","journal-title":"Eur Mod Stud J"},{"issue":"7","key":"pone.0327114.ref011","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1001\/jama.2020.10371","article-title":"Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force","volume":"324","author":"JT Henderson","year":"2020","journal-title":"JAMA"},{"issue":"3","key":"pone.0327114.ref012","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1080\/19317611.2017.1307300","article-title":"Comparison of Two Psycho-Educational Interventions Aimed at Preventing HIV and Promoting Sexual Health Among Portuguese Women","volume":"29","author":"ECV Costa","year":"2017","journal-title":"International Journal of Sexual Health"},{"issue":"91","key":"pone.0327114.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta20910","article-title":"The Men\u2019s Safer Sex project: intervention development and feasibility randomised controlled trial of an interactive digital intervention to increase condom use in men","volume":"20","author":"JV Bailey","year":"2016","journal-title":"Health Technol Assess"},{"issue":"3","key":"pone.0327114.ref014","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.jadohealth.2012.07.005","article-title":"Reducing sexual risk behavior in adolescent girls: results from a randomized controlled trial","volume":"52","author":"D Morrison-Beedy","year":"2013","journal-title":"J Adolesc Health"},{"issue":"1","key":"pone.0327114.ref015","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1093\/her\/cyu015","article-title":"Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females","volume":"30","author":"CA Redding","year":"2015","journal-title":"Health Educ Res"},{"issue":"1","key":"pone.0327114.ref016","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1186\/s12879-022-07534-9","article-title":"Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review","volume":"22","author":"K Martin","year":"2022","journal-title":"BMC Infect Dis"},{"issue":"4","key":"pone.0327114.ref017","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/1753-6405.12680","article-title":"Barriers to sexually transmitted infection testing in New Zealand: a qualitative study","volume":"41","author":"HJ Denison","year":"2017","journal-title":"Aust N Z J Public Health"},{"issue":"5","key":"pone.0327114.ref018","doi-asserted-by":"crossref","first-page":"3002","DOI":"10.3390\/ijerph19053002","article-title":"HIV and STI Testing Preferences for Men Who Have Sex with Men in High-Income Countries: A Scoping Review","volume":"19","author":"V Kularadhan","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0327114.ref019","volume-title":"Auszug aus dem substanziellen Protokoll 44. 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How young adults in Canada and South Africa prefer to receive STI results, counseling, and treatment updates in a wireless world","volume":"18","author":"L Labacher","year":"2013","journal-title":"J Health Commun"},{"key":"pone.0327114.ref028","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3389\/fpsyg.2018.00064","article-title":"Preferences for Online and\/or Face-to-Face Counseling among University Students in Malaysia","volume":"9","author":"KP Wong","year":"2018","journal-title":"Front Psychol"},{"key":"pone.0327114.ref029","doi-asserted-by":"crossref","first-page":"104234","DOI":"10.1016\/j.ijnurstu.2022.104234","article-title":"The effect of universal voluntary HIV counseling and testing on epidemiological, behavioral, and psychosocial outcomes: An umbrella review of systematic reviews and meta-analyses","volume":"130","author":"LJ Cheng","year":"2022","journal-title":"Int J Nurs Stud"},{"issue":"9","key":"pone.0327114.ref030","doi-asserted-by":"crossref","first-page":"21051","DOI":"10.2807\/1560-7917.ES2015.20.9.21051","article-title":"Opportunistic testing for urogenital infection with Chlamydia trachomatis in south-western Switzerland, 2012: a feasibility study","volume":"20","author":"F Bally","year":"2015","journal-title":"Euro Surveill"},{"key":"pone.0327114.ref031","doi-asserted-by":"crossref","DOI":"10.4414\/smw.2020.20393","article-title":"The Swiss STAR trial - an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women","volume":"150","author":"PL Vernazza","year":"2020","journal-title":"Swiss Med Wkly"},{"issue":"4","key":"pone.0327114.ref032","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1136\/sextrans-2017-053363","article-title":"The Denominator problem: estimating the size of local populations of men-who-have-sex-with-men and rates of HIV and other STIs in Switzerland","volume":"95","author":"AJ Schmidt","year":"2019","journal-title":"Sex Transm Infect"},{"issue":"9","key":"pone.0327114.ref033","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0044819","article-title":"Resurgence of HIV infection among men who have sex with men in Switzerland: mathematical modelling study","volume":"7","author":"A van Sighem","year":"2012","journal-title":"PLoS One"},{"issue":"4","key":"pone.0327114.ref034","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1111\/1475-6773.12444","article-title":"High Out-of-Pocket Medical Spending among the Poor and Elderly in Nine Developed Countries","volume":"51","author":"K Baird","year":"2016","journal-title":"Health Serv Res"},{"key":"pone.0327114.ref035","volume-title":"Evaluation der KulturLegi; Bericht zuhanden der Gesch\u00e4ftsleitungsstelle KulturLegi Schweiz","author":"H Amberg","year":"2019"},{"issue":"2","key":"pone.0327114.ref036","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1111\/hiv.13175","article-title":"Participation, retention and uptake in a multicentre pre-exposure prophylaxis cohort using online, smartphone-compatible data collection","volume":"23","author":"F Hovaguimian","year":"2022","journal-title":"HIV Med"},{"key":"pone.0327114.ref037","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s13063-016-1286-4","article-title":"An analysis of baseline data from the PROUD study: an open-label randomised trial of pre-exposure prophylaxis","volume":"17","author":"DI Dolling","year":"2016","journal-title":"Trials"},{"key":"pone.0327114.ref038","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1080\/09540121.2016.1146653","article-title":"Uptake of PrEP and condom and sexual risk behavior among MSM during the ANRS IPERGAY trial","author":"L Sagaon-Teyssier","year":"2016","journal-title":"AIDS Care"},{"issue":"8","key":"pone.0327114.ref039","article-title":"Daily and on-demand HIV pre-exposure prophylaxis with emtricitabine and tenofovir disoproxil (ANRS PREVENIR): a prospective observational cohort study","volume":"9","author":"J-M Molina","year":"2022","journal-title":"Lancet HIV"},{"issue":"5","key":"pone.0327114.ref040","article-title":"Sexual behaviour and incidence of sexually transmitted infections among men who have sex with men (MSM) using daily and event-driven pre-exposure prophylaxis (PrEP): Four-year follow-up of the Amsterdam PrEP (AMPrEP) demonstration project cohort","volume":"21","author":"MAM van den Elshout","year":"2024","journal-title":"PLoS Med"},{"key":"pone.0327114.ref041","unstructured":"Barrense-Dias Y, Akre C, Berchtold A, Leeners B, Morselli D, Suris JC. Sexual health and behavior of young people in Switzerland. 2018."},{"key":"pone.0327114.ref042","unstructured":"Centers for Disease Control and Prevention CDC. Trends in the prevalence of sexual behaviors and HIV testing: National YRBS 1991\u20132019. 2021. https:\/\/www.cdc.gov\/yrbs\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/healthyyouth\/data\/yrbs\/factsheets\/2019_sexual_trend_yrbs.htm"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0327114","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:29:05Z","timestamp":1775064545000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0327114"}},"subtitle":[],"editor":[{"given":"Ismael","family":"Maatouk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0327114","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}