Background Routine HIV pre-exposure prophylaxis (PrEP) and HIV care appointments provide opportunities for screening men who have sex with men (MSM) for hepatitis C virus infection (HCV). However, levels of screening required for achieving the WHO elimination target of reducing HCV incidence by 90% by 2030 among all MSM are unknown.

Methods An HCV/HIV transmission model was calibrated to UK prevalence of HIV (5·9%) and chronic HCV infection among HIV-positive MSM (10·0%). Assuming 12·5% coverage of PrEP among HIV-negative MSM, we evaluated the impact on HCV incidence (2018–2030) of HCV screening every 12/6/3-months (and completing treatment within 6 months of diagnosis) in PrEP users and/or HIV-diagnosed MSM. We then estimated the additional screening required among HIV-negative non-PrEP users to achieve a 90% reduction in overall incidence by 2025/2030. The effect of a 50% reduction in condom use among PrEP users (risk compensation) was estimated.

Results Without risk compensation, PrEP scale-up decreases HCV incidence by 9·5% by 2030, whereas it increases by 26·5% with risk compensation. Screening and treating PrEP users for HCV every 12/6/3-months decreases HCV incidence by 41/46/48%, respectively, increasing to 74/81/83% if HIV-diagnosed MSM are also screened at the same frequencies. Risk compensation reduces these latter projections by <5%. To achieve a 90% reduction in HCV incidence by 2030 (values in bracket are with risk compensation), HIV-negative MSM not on PrEP require screening every 5·2 (4·5) years if MSM on PrEP and HIV-diagnosed MSM are screened every 6-months, decreasing to every 2·6 (2·3) years for the 2025 target. For 25% PrEP coverage, then the 2030 HCV elimination target may be reached without screening HIV-negative MSM not on PrEP.

Conclusion Increased screening of all MSM (particularly HIV-diagnosed MSM and MSM on PrEP) is required to achieve the WHO HCV-elimination targets for MSM in the UK.

Disclosure No significant relationships.