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«Pre-exposure prophylaxis» (PrEP) refers to the use of an antiretroviral medication to prevent HIV negative people from acquiring the infection and is an effective measure to complement existing HIV prevention strategies among populations with a high risk of HIV infection. Despite its lack of formal approval in Switzerland, PrEP use needs to be monitored carefully for multiple reasons:
A growing number of people in Switzerland already use PrEP bought online, often without medical supervision. This puts PrEP users not only at risk of drug-related side effects (such as kidney failure), but may also lead to subsequent viral resistance in those taking PrEP despite a latent, undiagnosed HIV infection.
Another concern is that PrEP might result in changes in sexual behavior: PrEP use is associated with an increase in condomless sex, which may in turn facilitate the transmission of other sexually transmitted infections (STIs).
Finally, sexual minorities have been found to suffer from a higher rate of depression, suicide and problematic substance use, which further underlines the need for appropriate care and mental health screening. The prospective cohort study SwissPrEPared aims to longitudinally follow people at risk of HIV who seek PrEP, over a period of 3 years. The SwissPrEPared Study is nested within the «SwissPrEPared Program», which is a nation-wide prevention program for the surveillance and exchange of experiences related to PrEP. The goal of the program is to ensure high quality care for individuals seeking PrEP. The main objectives of the SwissPrEPared Study will be:
Ultimately, the SwissPrEPared Program and nested study intend to provide a better understanding of the needs, expectations and vulnerabilities of individuals seeking PrEP. With better-targeted prevention measures and improved access to care, HIV incidence rates may further decrease in Switzerland. Also, through systematic HIV screening at entry, the SwissPrEPared program will help identify HIV-infected individuals unaware of their condition and thus bring a substantial contribution to reaching the UNAIDS 90% targets (i.e. 90% of people living with HIV are informed about their HIV status; 90% of people diagnosed with HIV receive sustained antiretroviral treatment (ART); 90% of all people on ART have viral suppression).
For more information and to participate please visit the project page.
Project lead: Benjamin Hampel & Jan Fehr
Funding: Federal Office of Public Health, Swiss HIV Cohort Study
Diabetes mellitus (DM) is one of the most common non-communicable diseases worldwide. The number of people with diabetes is increasing rapidly, especially in sub-Saharan Africa. In addition, it is estimated that up to 60% of patients with diabetes are undiagnosed. With the growing prevalence of type 2 diabetes in the general population, it is expected that the prevalence of gestational diabetes mellitus (GDM) will also increase. GDM is defined as glucose intolerance with onset or first recognition during pregnancy and is associated with maternal and fetal adverse outcomes. To date, epidemiological data from sub-Saharan countries is scarce, and comparability is hampered by varying screening methods and diagnostic criteria. With this observational study we aim to establish a diabetes screening program for GDM, and to obtain epidemiological data on the prevalence of GDM in HIV positive women. We recently started recruitment at the Prevention, Treatment & Care Unit of the Infectious Diseases Institute (IDI) in Kampala, Uganda and have thus far screened 133 women (December 2019).
For more information and to participate please visit the project page.
Project lead: Sabine Haller
Funding: Uniscientia Stiftung
Online dating applications have recently gained increasing popularity in both the heterosexual population and amongst sexual minorities. In a recent report, nearly 75% of men-who-have-sex-with-men (MSM) reported to having met a sexual partner using dating apps. In Switzerland, 62,000 MSM are estimated to use online dating apps.
There are concerns about the effect of these dating apps on the physical and mental health of their users. Recent studies have shown that MSM using online dating apps appear more likely to engage in high risk sexual behaviour, thereby increasing their risk of contracting HIV and other STIs. App usage has also been found to have negative effects on mental health (e.g. elevated levels of anxiety or depression), which is problematic since sexual risk-taking increases with depression. Determining when dating app usage becomes detrimental, however, is challenging. To date, a variety of app addiction scales have been developed to assess how app usage patterns may affect health, but none of these scales directly address online dating addiction (ODA).
Our project will be the first to provide insights into the prevalence of ODA in the MSM population. Analysing the association of ODA with sexual and mental health outcomes may identify novel drivers of the current HIV/STI epidemic in Switzerland; thus providing critical information to shape future prevention measures. Finally, considering that more than 41 million people currently use dating apps in Europe, our findings may provide crucial insights about a phenomenon involving populations beyond sexual minorities.
This is a sub-study of the SwissPrEPared program and nested study.
For more information and to participate please visit the project page.
A multicenter, observational cohort to study the characteristics of individuals asking for pre-exposure prophylaxis (PrEP) and the incidence of HIV and STIs: "The Swiss PrEPared Study"
Project lead: Jan Fehr & Benjamin Hampel
Funding: Swiss National Science Foundation
Sexual health plays an important role for the population of the city of Zurich. The wide range of education, employment and leisure activities attracts young people, who in general are sexually active. Moreover, Zurich has a long tradition of tolerance towards sexual minorities, especially lesbian-, gay-, bisexual- and transgender (LGBT) community. Thus, the proportion of the population of men having sex with men is substantially larger than the national average. Due to the specific population structure, it is not surprising that a substantial number of the national HIV and STI cases are diagnosed in Zurich. Hence, focusing the resources to combat HIV and STIs on larger cities as Zurich might speed up the elimination of HIV. Encouraging people at risk of having contracted HIV or STIs to regularly get tested is an important part of newer prevention efforts such as HIV pre-exposure prophylaxis (PrEP) or “treatment as prevention”. However, asymptomatic testing is not covered by the basic health insurance in Switzerland and outside of special, time-limited campaigns, there is no free or easily affordable HIV or STI testing available in Zurich. Since the most sexually active population often coincides with the young and thus financially less secure population, the costs of getting HIV and STI testing might be a prohibiting factor for a substantial part of the population who should get tested. The city of Zurich has recognized this dilemma and is offering free HIV and STI testing for its youth and young adults, as well as other people living in Zurich with small incomes (KulturLegi holders) during a pilot phase of three years. Since this is a unique situation, as the effectiveness of introducing free or discounted HIV testing has been shown in resource-limited settings but not in industrialized countries, we are following the pilot project with a study. The objective of this observational mixed-methods study is to evaluate the city of Zurich’s pilot project offering free HIV and STI tests to its youth or people having a low income (measured by eligibility for the KulturLegi). Specifically, this study aims to (i) collect data on the demographic and epidemiological characteristics of individuals benefiting from the project, (ii) assess the feasibility of the free testing intervention, (iii) assess changes in the age distribution of people accessing PrEP, (iv) assess whether the most relevant vulnerable populations are being reached, as well as (v) assess the health status in this specific study population, including general and sexual well-being and mental health.
For more information and to participate please klick here: Gratis HIV und STI Test
Contact for Study: testi@ebpi.uzh.ch
DEUTSCH
Machbarkeit von gratis HIV und STI Tests in der Bevölkerung der Stadt Zürich bis 25 und deren Einfluss auf das Testverhalten und auf den Gesundheitszustand in dieser Bevölkerung (teSTI)
Die sexuelle Gesundheit spielt für die Bevölkerung der Stadt Zürich eine wichtige Rolle. Das breite Angebot an Bildungs-, Arbeits- und Freizeitaktivitäten zieht junge Menschen, die im Allgemeinen sexuell aktiv sind, an. Darüber hinaus hat Zürich eine lange Tradition der Toleranz gegenüber sexuellen Minderheiten, insbesondere der Lesben-, Schwulen-, Bisexuellen- und Transgender-Gemeinschaft (LGBT). So ist der Anteil der Männer, die Sex mit Männern haben, deutlich höher als im nationalen Durchschnitt. Aufgrund der spezifischen Bevölkerungsstruktur ist es nicht verwunderlich, dass ein erheblicher Teil der nationalen HIV- und STI-Fälle in Zürich diagnostiziert wird (STI=sexuell übertragbare Infektion/Krankheit). Eine Konzentration der Ressourcen zur Bekämpfung von HIV und STI auf grössere Städte wie Zürich könnte daher die Ausrottung von HIV und anderen Infektionskrankheiten beschleunigen. Menschen mit einem HIV- oder STI-Risiko zu ermutigen, sich regelmäßig testen zu lassen, ist ein wichtiger Bestandteil neuerer Präventionsmassnahmen wie der HIV-Präexpositionsprophylaxe (PrEP) oder der "Behandlung als Prävention". Asymptomatische Tests werden in der Schweiz jedoch nicht von der Krankengrundversicherung übernommen, und abgesehen von speziellen, zeitlich begrenzten Kampagnen gibt es in Zürich keine kostenlosen oder günstigen HIV- oder STI-Tests. Da die sexuell aktivste Bevölkerung oft mit der jungen und damit finanziell weniger abgesicherten Bevölkerung zusammenfällt, könnten die Kosten für HIV- und STI-Tests für einen beträchtlichen Teil der Bevölkerung, die sich testen lassen sollte, ein Hindernis darstellen. Die Stadt Zürich hat dieses Dilemma erkannt und bietet während einer Pilotphase von drei Jahren kostenlose HIV- und STI-Tests für ihre Jugendlichen und jungen Erwachsenen sowie für andere in Zürich lebende Menschen mit geringem Einkommen (KulturLegi-Inhaber) an. Dies ist – in einem Industrieland – eine einzigartige Massnahme: die Wirksamkeit der Einführung kostenloser oder vergünstigter HIV-Tests in ressourcenbeschränkten Umgebungen wurde bereits nachgewiesen; in Industrieländern wurde eine solche Initiative aber noch nicht getestet. Das EBPI begleitet jenes Pilotprojekt mit einer wissenschaftlichen Studie. Ziel dieser Beobachtungsstudie ist es, das Pilotprojekt der Stadt Zürich zu evaluieren, in dessen Rahmen Jugendlichen und Personen mit geringem Einkommen (gemessen an der KulturLegi) kostenlose HIV- und STI-Tests angeboten werden. Konkret zielt diese Studie darauf ab, (i) Daten zu den demografischen und epidemiologischen Merkmalen der Personen zu erheben, die von dem Projekt profitieren, (ii) die Durchführbarkeit der kostenlosen Testintervention zu bewerten, (iii) Veränderungen in der Altersverteilung der Personen, die PrEP in Anspruch nehmen, zu bewerten, (iv) zu beurteilen, ob die wichtigsten gefährdeten Bevölkerungsgruppen erreicht werden, sowie (v) den Gesundheitszustand in dieser speziellen Studienpopulation zu bewerten, einschließlich des allgemeinen und sexuellen Wohlbefindens und der psychischen Gesundheit.
Für Informationen und um an der Studie teilzunehmen, klicken Sie btte hier:Gratis HIV und STI Test
Project lead: Benjamin Hampel
Funding: Stadt Zürich
Sexual health during and after travel: Integrating proven approaches from the prevention of HIV and sexually transmitted infections into counseling at the Center for Travel Medicine.
Zeroing In Ending the HIV Epidemic:
Reaching the other half of the pandemic: A pilot project to implement sexual risk assessment and HIV prevention into Switzerland’s biggest center for travel medicine
Why is it important to counsel travelers for prevention of sexual risk?
With the implementation of the HIV Pre-Exposure Prophylaxis (PrEP), many regions of the world experienced a historical decline in new HIV diagnoses. In Western countries, PrEP has been used and promoted primarily among men who have sex with men (MSM). In Switzerland, most HIV infections among non-MSM are transmitted during traveling including people visiting friends and relatives in their home countries abroad. HIV prevention measures often do not reach these specific groups of travelers. Visits to travel clinics are a window of opportunity to reach this population with prevention measures. However so far, evidence and expertise from the field of HIV prevention, for example from the SwissPrEPared program*, has not been integrated systematically into travel medicine. Accordingly, as one of many steps to end the HIV pandemic, it will be important to implement evidence-based HIV prevention measures into services of travel medicine.
* The SwissPrEPared program is intended to improve medical care for PrEP users and people interested in PrEP, especially MSM. Moreover, the program intends to implement medical guidelines for health care professionals, keep them up to date with the current PrEP science and provide training on PrEP. For more information visit the website.
Who we are and what we aim for?
We are a team of health professionals with expertise in travel medicine and/or in HIV and sexually transmitted infection (STI) -prevention and treatment. The team consists of staff from the Zentrum für Reisemedizin (ZRM) of the University of Zurich and the Checkpoint Zürich:
The ZRM is a 'WHO Collaborating Center' for 'Traveller's Health'. In the scope of our public health mission, synergies between services, research and teaching are used to promote innovative services.
The Checkpoint Zurich is one of the largest health centers in Switzerland for HIV/STI and sexual health, especially for queer people. The center offers medical, psychological and psychosocial services.
Organized as a project group, we started a project called Travel PrEPared with the aim to develop and evaluate a travel client-centered HIV/STI counseling and testing program with a focus on PrEP integration, based on the success of the SwissPrEPared program.
This includes development of implementation strategies, such as the definition of new counseling pathways and training for health professionals in travel medicine.
How are we going to develop and implement SwissPrEPared into travel medicine?
The Travel PrEPared project will be organized along the six steps described below.
By the end of the project a new care pathway in travel medicine will enable sensibilization of travelers for sexual health and will allow the identification of travelers with special needs in this respect. A travel-specific SwissPrEPared counseling and treatment program will be available in a pilot-tested format, as well as the respective training program for health care professionals.
Step 1: Context- and needs assessment
We conduct a context- and needs assessment to better understand travelers and health professional's perspectives, experiences and needs with sexual health during travel or in respect to travel related counseling. Additionally, we assess the current structures and processes of travel medicine services.
We will conduct 20-30 depth qualitative interviews with travel medicine experts, as well as travelers that will be analyzed using reflexive thematic analysis (1). Additionally, the current counseling and treatment structures and processes will be mapped based on document review and information from the interviews.
(1) Braun V., Clarke V. (2022). Thematic Analysis a practical guide. London, SAGE Publications Ltd. ISBN 978-1-4739-5323-9
Step 2: Development of a care pathway and training
Based on the results of the first step and the insights gained from the SwissPrEPared program, the project group will develop both a new care pathway and a training program for health professionals. The new care pathway will allow systematic sensibilization for sexual health for all travel-clients and as well as screening for travel-clients that will profit from specific services such as PrEP. The training program for health professionals from travel medicine will enable them to provide such services.
Step 3: Adaptation and expansion of SwissPrEPared tool for travel health
The SwissPrEPared program works with a patient registry tool specifically created so that participants can fill out questionnaires before their consultations and no information is missed during the counselling session with the health care worker. The data entered by the participants and health care workers will, upon giving (optional) consent by participants, be used for additional study purposes.
The Travel PrEPared project group, other health professionals, some clients as well as technicians will be involved in the adaptation and usability testing of the new travel-medicine oriented SwissPrEPared-tool. The process will continue until the team considers the tool to be ready for pilot-testing.
Step 4: Implementation and evaluation of the new services
The new service including sensibilization, screening and PrEP counseling with the adapted tool will be evaluated in respect to implementation outcomes such as coherence with the setting, cognitive participation and collective action of involved health care professionals as well as their reflection on changes due to the new practice. Based on these results adaptations and improvements will be suggested and/or made.
Step 5: Communication and dissemination of first findings
Given the fact that internationally evidence from HIV/STI prevention has only marginally been implemented into travel medicine, we plan to communicate results from the needs assessment and pilot-evaluation at conferences and through publications.
Project lead: Dunja Nicca & Benjamin Hampel
Funding: Gilead Sciences
