[Impact of a national policy change on rapid diagnostic testing for HIV, hepatitis C and syphilis by lay providers in community-based organisations and local public health centres: a cross-sectional study].

Background: To improve the diagnosis of undetected infections with the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and syphilis infections among key populations, Section 24 of the Infection Protection Act was amended. Since 1 March 2020, non-medical staff have also been permitted to perform rapid tests. This study aims to examine the impact of the legal change in low-threshold AIDS and drug services as well as in public health offices.

Methods: In a cross-sectional survey, 274 drug services, 100 member organisations of the German AIDS Service Organisation and 342 public health offices were invited to take part in an online questionnaire. Topics included facility structure, service provision and the acceptance, implementation and effects of the legal change. Data were analysed descriptively; where sample size allowed, results were differentiated by facility type.

Results: Of the 716 facilities contacted, 286 participated. After the legal change, 80 (28%) introduced rapid testing by non-medical staff. Facilities with existing testing services were more likely to adopt testing by non-medical staff than those without prior experience (56.8% vs. 13.6%). The average monthly number of HIV, HCV, and syphilis rapid tests increased significantly. The number of reactive test results remained unchanged.

Conclusion: The legal change shows positive effects but there is still potential for broader implementation. Existing test infrastructure appears to support uptake. Additional support measures are needed to expand testing by non-medical staff. However, this alone is not sufficient to detect undiagnosed infections. Expansion and promotion of outreach testing services remain essential.