Evaluation of the hepatitis C testing strategy for HIV-positive men who have sex with men at the sexually transmitted infections outpatient clinic of Amsterdam, the Netherlands.

INTRODUCTION As the incidence of hepatitis C virus (HCV) infections remains high among HIV-positive men who have sex with men (MSM) an HCV testing strategy was introduced at the sexually transmitted infections (STI) clinic in Amsterdam in 2017. We aimed to evaluate this HCV testing strategy. METHODS HIV-positive MSM and transgender women (TGW) were eligible for HCV testing (anti-HCV and/or HCV RNA) at the STI clinic if they did not visit their HIV-clinician in the 3 months prior to the consultation and had not been tested for HCV at the STI clinic in the previous 6 months. All eligible individuals were administered the six questions on risk behaviour of the HCV-MOSAIC risk score; a risk score of ≥2 made a person eligible for testing. RESULTS From February 2017 through June 2018, 1,015 HIV-positive MSM and TGW were eligible for HCV testing in 1,295 consultations. Eleven active HCV infections (HCV RNA positive) were newly diagnosed (positivity rate 0.9%, 95%CI 0.4-1.5%). Sensitivity and specificity of the HCV-MOSAIC score for newly diagnosed active HCV infections were 80.0% (95%CI 49.0-94.3%) and 53.7% (95%CI 50.8-56.5%), respectively. If an HCV-MOSAIC score of ≥2 were used to determine whom to test, 46.6% of individuals currently tested for HCV would be eligible for testing. CONCLUSION Using the new HCV testing strategy, HCV testing was done in 1,295 consultations with HIV-positive MSM and TGW in 17 months. We newly diagnosed 11 active HCV infections. The HCV-MOSAIC risk score could reduce the number of tests needed, but some active HCV infections will be missed.