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Consequently, co-creation results in contextually appropriate intervention strategies as well as creation of a platform for co-learning and enhancing ownership and empowerment among the target group. Using a co-creational approach ensures that the design is pragmatic, local, and tailored to the target group and the specific settings for which it is created. This asks for strong collaboration between health care professionals, researchers, and the target group. Actively involving the target group in the development and implementation of an intervention is a promising approach to increase engagement of the target population.
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MC Free is the driving force behind the NoMoreC project, an innovative project co-created with the Amsterdam gay community. In 2016, we established the Amsterdam MSM Hepatitis C Free (MC Free) consortium with the goal of stopping HCV transmission among MSM in Amsterdam. Targeted socioculturally acceptable preventive measures, including behavioral interventions for MSM at risk of HCV infection, are scarce and urgently needed. These modeling studies indicate that early treatment in combination with the implementation of health promotion interventions that reduce high-risk behavior is an effective strategy to control the HCV epidemic in MSM.
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The model suggested that treatment plus counseling can reduce HCV prevalence among HIV-positive MSM. In this trial, a behavioral intervention that prevents HCV transmission through individual risk counseling was combined with early DAA treatment.
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In another modeling study, the potential impact of the Swiss HCVree Trial was assessed. Salazar-Vizcaya et al showed that prevention of high-risk behavior alone could result in a considerable reduction of HCV transmission among HIV-infected MSM based on different modeled scenarios on hypothetical behavioral and treatment interventions. Uptake of DAAs differs greatly between countries, and international HCV transmission in HIV-positive MSM persists.
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Įarly testing of at-risk MSM and immediate initiation of treatment prevent onward transmission, but this may not be sufficient to eliminate HCV in a population with ongoing risk behavior. The uptake of HCV treatment in HIV/HCV co-infected individuals in the Netherlands has been very rapid: 15 months after the introduction of DAA, 83% of HIV/HCV co-infected MSM were cured. In the Netherlands, unrestricted access to DAA for all chronically HCV-infected individuals has been available since 2015. In many countries, DAA therapy is available for patients with chronic HCV. Recent improvements in HCV therapy have resulted in multiple highly tolerable direct-acting antiviral (DAA) regimens with cure rates of over 95%. The incidence of HCV reinfection among HIV-positive MSM is 3-10 times higher than the primary infection incidence, and more recent data show ongoing HCV transmission among HIV-negative MSM using pre-exposure prophylaxis. 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. Since 2000, there has been an unexpected and substantial increase in HCV incidence among HIV- positive MSM globally. 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.
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In 2016, approximately 399,000 people died from HCV-related cirrhosis and liver cancer, and the number of deaths increases each year. 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.