TravelPrEPared

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.