The figure above shows the different levels that play an important role in the spread of HCV among MSM. We believe that only a combined approach which targets all levels is an effective way to reach our goal. Discerning these different levels also makes it possible to evaluate MC Free per segment. The objectives and activities of each level are described below.
On the level of the individual, MC Free strives to increase knowledge and awareness of HCV, stimulate regular testing and early diagnosis and reduce risk behavior. Through online tools we offer tailored advice about risk and testing to MSM who are at risk or suspect they are. These are linked to an accessible/low-threshold and reliable at-home testing service: the C-test. The testing service offers the option for an inexpensive C-test subscription to further promote regular testing and detect infections faster. Another intervention on the individual level is the NoMoreC Toolbox – a box filled with products men can use to reduce their risk of HCV.
MC Free focuses on the MSM community that is at risk of getting HCV. To eliminate HCV our emphasis on awareness within the community. There we work on knowledge and the social standard to take HCV seriously and take responsibility for each other. This is reflected in:
On the level of the professional MC Free is working on improving awareness, attitude, knowledge and skills regarding HCV. Within the NoMoreC project an e-learning module was developed and face-to-face training sessions are organized for health care professionals in primary- and secondary healthcare as well as the public health sector. These deal with (among others) HCV sex and drug related risks, risk reduction measures, testing options, partner notification and the benefits of early treatment.
Hosts of private sex parties, owners of commercial saunas, clubs, bars, fetish shops and dating apps who are part of the community are actively involved in MC Free. They receive briefings about HCV and measures that can be taken to reduce the risk of transmission. In this way we want to create an environment that facilitates risk reduction behavior. A practical example is visiting hosts and sex locations to demonstrate products that help to reduce the risk of transmission. Information is given on the use of these products and the places where they can be obtained. These community stakeholders also help us in promoting the NoMoreC project at these locations.
On the level of the patient we focus on fast referral to care, stimulating partner notification and increasing knowledge about HCV. The patient is informed on the clinical course and treatment of HCV and the prevention of further transmission. We also focus on preventing HCV re-infections through the development of behavior and test interventions that are specifically targeted at the group of people that has encountered HCV before (start summer of 2019). Through a randomized controlled trial (RCT) and mathematical model study we measure the impact of these interventions on HCV risk behavior.
HCV mainly occurs within specific sexual networks. Through MSM that have HCV and their social networks and specifically targeted promotion we want to reach those sexual networks in which HCV is prevalent. By means of peer-to-peer contact, MSM keep inform each other of the level of risk for HCV (snowball recruitment) and discount vouchers are distributed for the purchase of an RNA test. In this way MC Free wants to stimulate partner notification and testing behavior within the networks where HCV occurs.
Here we focus on understanding and predicting the HCV epidemic and the transmission dynamics among MSM. The output of mathematical models, centered on the situation in Amsterdam, is used to develop successful and cost-efficient test-and-treat methods. Innovative phylogenetic models with next-generation sequencing are used to investigate whether there are HCV infected MSM who contribute disproportionately to the onward transmission of HCV. This information is then used to further parameterize the mathematical model.