End Hep C SF placed the city on track to achieve the 2030 HCV elimination target set by the WHO among men who have sex with men who have ever injected drugs.
“Men who have sex with men (MSM) and also inject drugs are particularly vulnerable to HCV infection but are often omitted from HCV public health programs and elimination plans,” Meghan Morris, PhD, MPH, explains. “The number of MSM with HCV is three times higher than the general US population, and MSM who have ever injected drugs (MSM-IDU) have an even higher prevalence (30%) than MSM who had never injected drugs.”
Focusing elimination efforts on MSM-IDU could prevent infections in other MSM sub-groups, Dr. Morris says, noting that epidemic modelling enables researchers to determine the best strategy for achieving micro-elimination of HCV among MSM and to assess the importance of targeting MSM-IDU. “However, at the time of our study, MSM-IDU had not been accounted for in other modelling of HCV elimination.”
For a study published in The Journal of Infectious Diseases, the investigators—which included Dr. Morris as well as Peter Vickerman, BSc(Edin.), DPhil, and Adelina Artenie, PhD, MSc, BSc—estimated whether HCV testing and treatment approaches in San Francisco could enable the city to achieve the WHO HCV elimination target for HCV incidence among MSM-IDU by 2030.
The researchers conducted the study as part of San Francisco’s evidence-based elimination initiative, End Hep C SF, in partnership with the University of Bristol. They used epidemic models to generate estimates of the impact of select post-pandemic testing and treatment rebound scenarios on progress to achieving an 80% reduction in HCV incidence among MSM and MSM-IDU by 2030 in San Francisco. Models included HCV testing and treatment patterns for MSM and MSM-IDU starting in 2015 and accounted for changes observed during the COVID-19 pandemic.
San Francisco on Track to Eliminate HCV By 2030
The transmission model showed an HCV antibody prevalence of 15.5% in 2011 and an HIV prevalence of 32.8% in 2017 among ever MSM-IDU. The researchers observed high rates of HCV testing among MSM, with 79% to 86% ever tested between 2011 and 2019. MSM diagnosed with HCV had high rates of treatment, with 65% ever treated in 2018. Following COVID-19–related lockdowns, HCV testing and treatment declined by 59%.
“Our model estimates that HCV incidence had already decreased considerably, by approximately 70%, between 2015 and 2022 among MSM-IDU in San Francisco due to the city’s focus on scaling up testing, linkage to care, and treatment services for vulnerable communities, including MSM and people who inject drugs,” Dr. Morris says. “End Hep C SF’s focus included clinician education to address stigmatization and discrimination in providing HCV treatment to people who inject drugs. This early investment muted the negative impact of the COVID-19 pandemic on disrupting services and is likely a key reason the city appears to remain on track to achieve elimination by 2030, even if we conservatively assume no rebound in services to pre-pandemic levels (Figure).”
Clinicians “Essential” for Successful HCV Eradication
According to Dr. Morris, the study illustrates what can be achieved with the development of an HCV elimination program that focuses on vulnerable groups.
“With End Hep C SF, San Francisco developed the first city-focused strategic plan to eliminate HCV and an HCV ‘micro-elimination plan’ for people with HIV,” she says. “The city’s successful progress toward achieving the WHO 2030 target for HCV elimination is largely attributed to a multifaceted strategy that included scaling up testing, linkage to care, and treatment services for key high-risk subgroups, including MSM and people who inject drugs. Crucially, this strategy involved clinician education aimed at addressing stigma and discrimination often associated with providing HCV testing and treatment to members of marginalized communities.”
Clinicians are in a unique position to facilitate change by incorporating the study results into their practices, Dr. Morris continues. This includes providing drug-related risk reduction strategies along HCV treatment given the risk for IDU-related HCV acquisition among MSM.
“By fostering an environment of inclusivity, understanding, and empathy, clinicians can create a safe space for individuals to openly discuss their risk behaviors, including substance use and provide testing and treatment when needed,” she says. “Our findings emphasize that physicians are not only essential to the success of HCV elimination efforts but also have the power to reshape the narrative around stigmatized populations.”