Design and Implementation of a Multilevel Intervention to Reduce Hepatitis C Transmission Among Men who have Sex with Men in Amsterdam: a co-creation process (Preprint)

BACKGROUND In the Netherlands, transmission of hepatitis C virus (HCV) occurs primarily among men who have sex with men (MSM). Early HCV testing of at-risk MSM and immediate initiation of treatment will prevent onward transmission, but this may not be sufficient to eliminate HCV in a population with ongoing risk behaviors. Therefore, targeted socioculturally acceptable preventive measures, including behavioral interventions, are urgently needed. Currently, little contextually appropriate information about HCV or risk reduction interventions is available. OBJECTIVE The objective of this project was to develop an intervention to reduce HCV transmission among MSM in Amsterdam through a co-creation process, with the input of men from the targeted community directly impacting intervention content, design, and implementation. METHODS We developed a multilevel intervention targeting 6 levels: individual, community, professional, context, patient, and network. The intervention was developed in close cooperation between health professionals, gay community members, commercial stakeholders, and stakeholders from within the gay community. The co-creation process had 4 phases: a needs assessment, stakeholder engagement, co-creation, and implementation. The co-creation phase continued until consensus was reached between the researchers and community members on the intervention content and design. The final intervention, NoMoreC, was completed within 2 years, and implementation started in February 2018. RESULTS NoMoreC includes web-based and face-to-face components as well as an anonymous HCV testing service. The NoMoreC website provides information about hepatitis C, HCV transmission routes, risk reduction strategies, testing and treatment options, and partner notification. The face-to-face component comprises a risk reduction toolbox, training for health professionals, and providing tailored advice to sex on premises venues. NoMoreC is promoted by an active voluntary campaign team. CONCLUSIONS Involving the community and stakeholders in the creation of NoMoreC has been the main strength of this project. It has resulted in an intervention with various components that resonates with the gay community at risk of HCV infection. The uptake and acceptability of the described intervention will be evaluated in the future. The description of the co-creation process and implementation of the project may serve as a rich and useful source for others who want to develop culturally and context appropriate HCV interventions.