BACKGROUND Gay and bisexual men (GBM) are a key population affected by HIV and hepatitis C (HCV) co-infection. Providing HCV treatment scale-up across specialist and non-hepatitis specialist settings may eliminate HCV in this population. We aimed to (1) deliver and measure HCV treatment effectiveness, and (2) determine the population impact of treatment on HCV prevalence and incidence longitudinally. METHODS The co-EC Study (Enhancing care and treatment among HCV/HIV co-infected individuals to Eliminate Hepatitis C transmission) was an implementation trial providing HCV direct-acting antiviral treatment in Melbourne, Australia, from 2016-2018. Individuals with HCV/HIV co-infection were prospectively enrolled from primary and tertiary-care services providing care for 85% of GBM with HIV in our jurisdiction. HCV-viraemic prevalence and HCV-antibody/viraemic incidence were measured using a state-wide, individually-linked, electronic surveillance system. RESULTS Among 200 participants recruited, 186 initiated treatment during the study period. Sustained virological response among primary care participants (98%, 95%CI:93-100%) was not different to tertiary care (98%, 95%CI:86-100%). From 2012-2019, between 2434 and 3476 GBM with HIV-infection attended our primary-care sites annually providing 13,801 person-years of follow-up; 50-60% received an HCV test annually, 10-14% were anti-HCV positive. Among those anti-HCV positive, viraemic prevalence declined 83% during the study (54% to 9%; 2016 to 2019). HCV incidence decreased 25% annually from 1.7/100 person-years in 2012 to 0.5/100 person-years in 2019 (incidence rate ratio 0.75; CI:0.68-0.83;p<0.001). CONCLUSION High treatment effectiveness by non-specialists demonstrates the feasibility of treatment scale-up in this population. Substantial declines in HCV incidence and prevalence among GBM with HIV-infection provides proof-of-concept for HCV micro-elimination. REGISTRATION ClinicalTrials.gov (Identifier: NCT02786758).

OBJECTIVEHIV Pre-exposure prophylaxis (PrEP) decreases risk of HIV acquisition however its efficacy is closely dependent on adherence. There is also concern that the preventive effect of PrEP may be offset by risk compensation, notably an increase in condomless anal sex.DESIGNMulti-site, open-label demonstration study that recruited people at current or recent risk of HIV infection in Melbourne, Australia.METHODSParticipants were recruited from three general practice clinics and one sexual health clinic in Melbourne and consented to take daily tenofovir/emtricitabine for 30 months. Sexual practice data, HIV and sexually transmitted infection (STI) test results were collected at baseline and 3-monthly during follow up. PrEP adherence was evaluated by self-report at clinical visits, online surveys, refill-based assessments and dried blood spot (DBS) testing. We present a 12-month interim analysis.RESULTS114 people were recruited. We observed a significant decline in condom use which occurred concomitantly with a significant increase in STIs over the first 12 months of PrEP. Incidence (per 100PY) of any STI was 43.2 and 119.8 at m0-3 and M3-12, respectively (IRR 2.77 (1.52, 5.56)). Adherence to PrEP medication was high by all measures, including six month TDF-FTC levels in DBS.CONCLUSIONSWe found significant reduction in condom use and an increase STIs over the first 12 months of follow-up. High medication adherence rates coupled with a decline in condom use and a rise in STIs, suggests that prevention, early detection and treatment of STIs is a chief research priority in the current era of HIV PrEP.

Background Over the past five years there have been increasing reports of HCV transmission in HIV-positive men who have sex with men (MSM) globally. It is unclear whether this increase is due to increased transmission or increased detection (due to increased testing). This paper investigated reasons for increased HCV notification in HIV-positive MSM. Methods HIV viral load test records between April 2006 and December 2011 were used to identify all HIV-positive patients attending three high MSM caseload clinics in Melbourne, Victoria. Their HCV test records were retrospectively linked over the same period. The following were determined: frequency of HCV testing; proportion of HIV-positive men tested for HCV annually; and HCV prevalence and incidence rate (per 100PY). Poisson regression calculated trends over time. Results 3007 HIV-positive men attended the clinics; 2190 (73%) were tested for HCV at least once, with 250 (11.4%) testing HCV positive over the study period. The prevalence of co-infection declined significantly from 11.9% in 2006 to 7.4% in 2011 (p = 0.01). The number of HIV-positive men tested for HCV increased each year although the proportion tested remained the same (approximately 75%) and testing frequency did not change (average 1.4 test/person/year). 187 HIV-positive men were identified with HCV on their initial test and 63 incident infections were observed. HCV incidence among HIV-positive men was 1.55/100PY with no significant change over the study period. Conclusions We found that HCV incidence in HIV-positive MSM remained stable and that prevalence decreased in HIV-positive MSM throughout the study period. Our results suggest the increase in HCV case notifications among HIV-positive men may be explained by an overall increase in HCV testing in this population. The steady increase in the number of HIV-positive MSM who remain well and consequently routinely tested for HCV may be contributing the increase in HCV notifications.