Assessing the efficiency and effectiveness of community-based voluntary counseling and testing for HIV in Turin: insights from the fast-track cities initiative - a cross-sectional study

Background: This study evaluated the efficiency and effectiveness of Community-Based Voluntary Counseling and Testing (CBVCT) for HIV in Turin as part of the Fast-Track Cities initiative. It aimed to understand demographic characteristics and risk behaviors to identify factors associated with routine testing. The findings can help to better tailor interventions for reducing HIV transmission and improving public health outcomes. Methods: A cross-sectional design was employed, utilizing anonymous questionnaires administered throughout 2022. Participants were individuals attending rapid serological testing sessions for HIV organized by third-sector associations in Turin, Northern Italy. The sample comprised 795 participants who attended HIV testing sessions. Data were collected via paper-based questionnaires (n = 495), later digitized for analysis. Descriptive statistics, univariate, and logistic regression analyses were conducted to examine socio-demographic characteristics, risk behaviors, and testing outcomes. Cost-effectiveness was evaluated using a Markov model stratifying patients by CD4 + levels to assess QALYs and direct healthcare costs. Results: The study achieved a high HIV testing rate of 99.9%, with a positivity rate of 0.5%. All individuals with reactive tests were successfully linked to care. Syphilis testing had a lower uptake (76.7%) and identified a positivity rate of 0.7%. Significant demographic and behavioral differences were found: previously tested participants are more likely to be older (p < 0.001, OR = 1.15) than first-time testers, more likely to be MSM (Men who have Sex with Men) than MSF (Men who have Sex with Female) and FSM (Female who has Sex with Male) (p < 0.001, OR = 0.132; p < 0.001, OR = 0.183); and are more likely to have had a history of sexually transmitted infections (STIs)(p = 0.003, OR = 0.128). Immediate HIV diagnosis and access to antiviral therapy reduce healthcare costs by €3,841 per patient, with total savings of €23,808 due to lower treatment expenses before immunodeficiency onset. Conclusions: CBVCT programs in Turin demonstrated high feasibility and effectiveness in engaging the target population and ensuring linkage to care. However, syphilis testing requires greater integration. The findings highlight the need for targeted interventions to address disparities in testing behaviors and reinforce the economic sustainability of early HIV diagnosis and treatment.