Abstract
BackgroundIn the Netherlands, transmission of hepatitis C virus (HCV) occurs primarily among men who have sex with men (MSM). Early HCV testing of at-risk MSM and immediate initiation of treatment will prevent onward transmission, but this may not be sufficient to eliminate HCV in a population with ongoing risk behaviors. Therefore, targeted socioculturally acceptable preventive measures, including behavioral interventions, are urgently needed. Currently, little contextually appropriate information about HCV or risk reduction interventions is available.ObjectiveThe objective of this project was to develop an intervention to reduce HCV transmission among MSM in Amsterdam through a co-creation process, with the input of men from the targeted community directly impacting intervention content, design, and implementation.MethodsWe developed a multilevel intervention targeting 6 levels: individual, community, professional, context, patient, and network. The intervention was developed in close cooperation between health professionals, gay community members, commercial stakeholders, and stakeholders from within the gay community. The co-creation process had 4 phases: a needs assessment, stakeholder engagement, co-creation, and implementation. The co-creation phase continued until consensus was reached between the researchers and community members on the intervention content and design. The final intervention, NoMoreC, was completed within 2 years, and implementation started in February 2018.ResultsNoMoreC includes web-based and face-to-face components as well as an anonymous HCV testing service. The NoMoreC website provides information about hepatitis C, HCV transmission routes, risk reduction strategies, testing and treatment options, and partner notification. The face-to-face component comprises a risk reduction toolbox, training for health professionals, and providing tailored advice to sex on premises venues. NoMoreC is promoted by an active voluntary campaign team.ConclusionsInvolving the community and stakeholders in the creation of NoMoreC has been the main strength of this project. It has resulted in an intervention with various components that resonates with the gay community at risk of HCV infection. The uptake and acceptability of the described intervention will be evaluated in the future. The description of the co-creation process and implementation of the project may serve as a rich and useful source for others who want to develop culturally and context appropriate HCV interventions.
Highlights
Hepatitis C virus (HCV) infection is a major public health problem: An estimated 71 million people worldwide are living with chronic hepatitis C virus (HCV) infection, which, if left untreated, may progress to serious liver disease [1]
Involving the community and stakeholders in the creation of NoMoreC has been the main strength of this project
It has resulted in an intervention with various components that resonates with the gay community at risk of HCV infection
Summary
Hepatitis C virus (HCV) infection is a major public health problem: An estimated 71 million people worldwide are living with chronic HCV infection, which, if left untreated, may progress to serious liver disease [1]. In the Netherlands, HCV transmission occurs primarily among HIV-positive men who have sex with men (MSM), as HCV incidence dropped to nearly zero among people who inject drugs [3,4,5]. Since 2000, there has been an unexpected and substantial increase in HCV incidence among HIV- positive MSM globally [6,7]. Data from the international CASCADE collaboration demonstrated a significant overall increase in HCV incidence among HIV-positive MSM — from 0.07/100 person-years in 1990 to 1.8/100 person-years in 2017 [8]. In the Netherlands, transmission of hepatitis C virus (HCV) occurs primarily among men who have sex with men (MSM). HCV testing of at-risk MSM and immediate initiation of treatment will prevent onward transmission, but this may not be sufficient to eliminate HCV in a population with ongoing risk behaviors. Little contextually appropriate information about HCV or risk reduction interventions is available
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