Low Prevalence of HCV-Infection Among MSM in an Intervention for HCV Micro-Elimination in Rome Urge a Focus on High Risk Behaviours

Background/Objectives: HCV prevalence among men who have sex with men (MSM) is not negligible, but information in Italy is scarce, particularly for HIV-uninfected MSM. We report data from an HCV screening program targeted to MSM in Rome started in 2019 in two hospital settings and in four urban community-based (CB) settings run by NGOs. Methods: Adult MSM (>18 years old) presenting for HIV or Sexually transmitted infection testing or attending CB activities, have been invited to undergo, after providing informed consent, a free-of-charge rapid HCV Antibody test (OraQuick HCV®). For all participants, demographic, clinical and behavioural data using an anonymous questionnaire were collected. Free confirmatory standard serology tests were offered for those found reactive at rapid HCV test and then individuals with confirmed chronic HCV-infection, were referred though a dedicated “fast track” pathway for further clinical and laboratory assessment and DAA-treatment according to the national treatment guidelines. Results: From July 2019 and July 2023, 2.714 MSM agreed to be screened for HCV infection. Median age was 36 years (IRQ=29-46), 91.0% were Italians, 58,0% enrolled in the two clinical centers and 10,7% reported to be person living with HIV (PLWH). Overall, 9 (0,33%) MSM were found to be reactive for HCV-Ab at rapid test. Eight MSM were retested and 7 were confirmed as having chronic HCV infection (HCV viremia range: 8x103-23x106 IU/mL). The prevalence of confirmed cases was 0.26% (7/2,714; 95%CI: 0.10-0.53), higher in PLWH compared to those not reporting HIV infection (1.04% vs. 0.17, p=0.03). High-risk behaviours for HCV infection and/or history of Sexual Transmitted infection (STI) were recorded in all HCV confirmed cases. All seven persons were linked to care, clinically assessed and started DAA treatment, with sustained viral response (SVR) in all cases. Conclusions: These data suggest feasibility and potential effectiveness of a preventive program targeting MSM living in Rome, which combines HCV screening, case finding and linkage to prompt care. HCV-prevalence in the screened population, however, was quite low, although it is significantly higher in PLWH and in those with high-risk behaviours, suggesting that targeted screening of PLWH and individuals with high-risk behaviours may be more effective to achieve HCV eradication than universal screening.