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

The Limburg4Zero home-based sexual health care program distributed test kits to 906 MSM out of 1076 requested tests in a mixed urban-rural region of the Netherlands.

• 1076 tests were requested in total
• 906 MSM received a self-sampling STI/HIV test kit and sexual health information
• The program operated in Limburg, a mixed urban-rural region of the Netherlands
• The service included both self-sampling STI/HIV test kits and sexual health information

The return rate for laboratory testing among home-based care participants was 67%.

• Of the 906 MSM who received test kits, 67% returned samples for laboratory testing
• This metric reflects implementation fidelity and participant engagement with the self-sampling process
• The return rate was assessed as part of the systematic evaluation of implementation outcomes

Home-based care participants were more likely to have never previously tested for HIV compared to STI clinic attendees.

• 39% of home-based care participants had never tested for HIV before
• This compared to 28% of STI clinic attendees who had never previously tested for HIV
• This finding suggests the program reached a population not previously engaged with clinic-based sexual health services
• The difference indicates home-based care increased accessibility for previously untested individuals

The population reached by Limburg4Zero was predominantly highly educated and of Western ethnicity.

• Median participant age was 31 years
• Most participants had a university or college degree
• Most participants had a Western ethnicity
• This demographic profile suggests potential gaps in reaching lower-educated and non-Western MSM populations

Adoption of home-based sexual health care by healthcare providers (HCPs) was highly acceptable, though pragmatic and technical challenges were experienced.

• HCPs found the home-based care model highly acceptable overall
• Perceived pragmatic challenges were identified by implementers
• Technical challenges were also experienced during implementation
• Data were collected through in-depth interviews with implementers and field notes from monthly meetings

Key elements of the home-based care service were implemented as designed, with co-created adjustments made for optimization during the implementation period.

• Implementation fidelity was assessed as one of the systematic implementation outcomes using the practical, robust implementation and sustainability model (PRISM)
• Co-created adjustments were made collaboratively with stakeholders during implementation
• A community advisory board contributed insights alongside survey and in-depth interview data
• Monthly meetings with implementers provided field notes used in the evaluation

Long-term maintenance of the home-based sexual health care innovation was considered desirable by stakeholders, though future recommendations for efficient continuation were identified as necessary.

• Maintenance was assessed as one of the systematic implementation outcomes
• Stakeholders expressed desire for long-term continuation of the service
• Recommendations for efficient continuation were considered important for sustainability
• The mixed-methods design combined survey data, in-depth interviews, community advisory board insights, and field notes to assess maintenance

The study used the practical, robust implementation and sustainability model (PRISM) framework to systematically assess six implementation outcome domains.

• The six domains assessed were: contextual domains, population reached, effectiveness, adoption by healthcare providers, implementation fidelity, and maintenance
• A mixed-methods research design was employed
• Data sources included surveys and in-depth interviews from MSM participants and implementers, community advisory board insights, and field notes from monthly implementer meetings
• The study was conducted in Limburg, the Netherlands