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Hepatitis C: more testing and treatment needed for men who have sex with men

10 January 2020 

Relatively modest increases in Hepatitis C virus testing delivered through routine NHS appointments could help the UK meet the World Health Organization target for elimination of the virus in men who have sex with men, according to a study by researchers at the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol published in The Lancet journal EClinicalMedicine.

Doctor consulting with male patient in a clinical setting

The World Health Organization (WHO) has a target of reducing hepatitis C virus (HCV) infections by 90% by 2030. How that target might be reached among men who have sex with men in the UK is not known. Researchers at the University of Bristol have used mathematical modelling to predict how often they would need to be tested in order to meet the target.

Men who have sex with men (MSM), especially those who are HIV-positive, are at greater risk of HCV infection. In the UK, MSM who are HIV-positive are advised to be screened for HCV infection each year, while those who are HIV-negative are rarely tested. There are no HCV testing guidelines for those who take pre-exposure prophylaxis (PrEP), a new medication used to prevent HIV.

The researchers used mathematical modelling to project what frequency of HCV testing would be needed across all these MSM groups to meet the WHO’s reduction target. They took into account that taking PrEP may lead to men using condoms less often, increasing their HCV infection risk. They proposed two models for how the target could be met:

Model 1 

All the following conditions need to be met:

  • 12.5% of MSM who are eligible for PrEP take it up and are tested for HCV annually;
  • HIV-positive MSM are tested for HCV annually;
  • other MSM are tested for HCV alongside their existing HIV tests, which occur on average every 2-3 years; and
  • treatment of all those who are found to have HCV infection to be completed within 6 months. 

Model 2 

All the following conditions need to be met:

  • 25.0% of MSM who are eligible for PrEP take it up and are tested for HCV annually; 
  • HIV-positive MSM are tested for HCV annually; and 
  • treatment of all those who are found to have HCV infection to be completed within 6 months. 

The researchers also found that even if those who take PrEP were to use condoms half as often with their partners, the WHO reduction target would still be achievable at these testing frequencies.

Dr Louis Macgregor from the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol and lead author of the study, said: “We have shown that there are potentially great benefits to testing opportunistically for HCV infection alongside other routine appointments for MSM. Testing MSM who are eligible for PrEP presents a particularly promising opportunity and could make a big difference to efforts to meet the WHO elimination target for HCV infection in the UK. We hope that our research will be used to inform HCV testing guidelines.”

Paper: Scaling up screening and treatment for elimination of hepatitis C among men who have sex with men in the era of HIV pre-exposure prophylaxis. Louis Macgregor, Monica Desai, Natasha K. Martin, Jane Nicholls, Ford Hickson, Peter Weatherburn et al. Published in EClinicalMedicine. December 2019.


Further information

About the NIHR HPRU in Evaluation of Interventions at the University of Bristol

The Health Protection Research Unit (HPRU) in Evaluation of Interventions, based in Population Health Sciences at the University of Bristol, is part of the National Institute for Health Research (NIHR) and a partnership between University of Bristol and Public Health England (PHE), in collaboration with University College London, Cambridge Medical Research Council (MRC) Biostatistics Unit and University of the West of England. We are a multidisciplinary team undertaking applied research on the development and evaluation of interventions to protect the public’s health. Our aim is to support PHE in delivering its objectives and functions. Our focus is on the PHE priority area of infection. Follow us on Twitter: @HPRU_EI 

About the NIHR

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

  • funds, supports and delivers high quality research that benefits the NHS, public health and social care
  • engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
  • attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
  • invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
  • partners with other public funders, charities and industry to maximise the value of research to patients and the economy.

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.

This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. www.nihr.ac.uk/patientdata.