Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar;29(3):976-992.
doi: 10.1007/s10461-024-04579-6. Epub 2025 Jan 8.

Evaluating the Implementation of Home-Based Sexual Health Care Among Men Who Have Sex with Men: Limburg4zero

Cornelia Johanna Dorothy Goense  1   2   3 , Ymke J Evers  4   5 , Jonas Manait  6 , Christian J P A Hoebe  4   5   7 , Inge H M van Loo  7 , Dirk Posthouwer  7   8 , Robin Ackens  9 , Roland van Hooren  5 , Rocxanne Theuerzeit  5 , Rik Crutzen  6 , Sarah E Stutterheim  6 , Nicole H T M Dukers-Muijrers  10   11
Affiliations

Evaluating the Implementation of Home-Based Sexual Health Care Among Men Who Have Sex with Men: Limburg4zero

Cornelia Johanna Dorothy Goense et al. AIDS Behav. 2025 Mar.

Abstract

Home-based sexual health care (including self-sampling testing) could reduce barriers to clinic-based testing. This study systematically evaluated the implementation of home-based sexual health care ('Limburg4Zero') among men who have sex with men (MSM) in a mixed urban-rural region of the Netherlands. We systematically assessed implementation outcomes (contextual domains, population reached, effectiveness, adoption by health care providers (HCP), implementation fidelity, and maintenance) using the practical, robust implementation and sustainability model. We used a mixed-methods research design that combined survey and in-depth interview data from our priority population (MSM) and implementers with insights from our community advisory board and field notes from monthly meetings with the implementers. Of 1076 requested tests, 906 MSM received a (self-sampling STI/HIV) test kit and sexual health information. Most participants (median age 31) had a university or college degree and had a Western ethnicity. The return rate for laboratory testing was 67%. Home-based care participants more often never tested HIV before (39%) compared to STI clinic attendees (28%). Adoption by HCP was highly acceptable, although perceived pragmatic and technical challenges were experienced. Key elements of the home-based care service were implemented as designed, with co-created adjustments for optimization during the implementation. Maintaining the innovation in the long term was desirable, although future recommendations for efficient continuation should be considered. Implementation of home-based sexual health care has demonstrably increased care accessibility for MSM who had never previously been tested. Therefore, a systematic approach is crucial to foster the impact of home-based sexual health care.

Keywords: HIV testing; Home care services; Home-based sexual health care; Implementation science; MSM; STI testing; Self-sampling.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical Approval: The Medical Ethics Committee of Maastricht University Medical Center (MUMC +) exempted this study from official approval under prevailing laws in the Netherlands after official review as all data presented in this paper were retrospectively retrieved from regular STI clinic care activities and were de-identified, coded, and were analyzed in a pseudonymized way (METC number 2017-0251; 2020-2420).

Figures

Fig. 1
Fig. 1
Communication strategy considering communicational methods of Limburg4zero from April 2021 to January 2024
Fig. 2
Fig. 2
Flowchart from order to evaluation of home-based sexual health care in Limburg4zero
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022–2030. 2022. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/strat.... Accessed 13 Dec 2023.
    1. UNAIDS. 2025 AIDS targets. 2021. https://www.unaids.org/en/topics/2025_target_setting. Accessed 22 Mar 2024.
    1. European Centre for Disease Prevention and Control (ECDC). STI cases on the rise in Europe. 2024. https://www.ecdc.europa.eu/en/news-events/sti-cases-rise-across-europe. Accessed 31 October 2024.
    1. Aidsfonds Nederland. Amsterdam nadert 0 nieuwe hiv-infecties, nu rest van Nederland nog. 2023. https://aidsfonds.nl/nieuws/amsterdam-nadert-0-nieuwe-hiv-infecties-nu-r.... Accessed 6 May 2024.
    1. Rijksinstituut voor Volksgezondheid en Milieu (RIVM). Consult seksuele gezondheid—Deeldraaiboek 6—Testbeleid. 2024. https://lci.rivm.nl/draaiboeken/consult-seksuele-gezondheid. Accessed 16 Jan 2024.

LinkOut - more resources