Establishing the acceptability and feasibility of using social network-driven recruitment to test for hepatitis C in men who have sex with men.

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The problem: Hepatitis C virus (HCV) is a viral infection that can cause liver failure and liver cancer. We now have well tolerated and effective drugs to clear HCV. But up to 50% of the estimated 210,000 infected people in the UK do not know they are infected. If we find and treat all infected people we can decrease liver disease and stop HCV being spread to others. People who inject drugs (PWID) are the largest affected group in the UK. Most HCV testing strategies target PWID, but since 2000, increasing numbers of men who have sex with men (MSM), especially those with HIV, have been infected sexually with HCV. Their risk factors differ from PWID. More HIV negative MSM are getting HCV now so MSM at risk of HCV infection should be tested when attending sexual health (SH) clinics. But this does not always happen and many MSM do not attend SH clinics. So testing in SH clinics will miss some MSM at risk. Traditional partner notification-testing partners of those diagnosed with HCV- is often impossible to do as often there are many anonymous untraceable partners.The approach: I will develop and pilot a social network driven recruitment (SNDR) intervention to find and offer testing to people who are at risk of HCV but who are not already being tested. Risk of HCV depends on the risk in the people one socialises with as well as has sex with. Social contacts influence behaviour and what is accepted as 'normal', including risky behaviour. More information about testing behaviours in these networks could allow better targeting of testing and a means to reach those not engaged with care. Studies have used a participant (known as a seed) to recruit social (including sexual) peers from their networks (alters) who in turn recruit their alters to reach 'hidden' populations. Adaptations to this method have helped find undiagnosed HIV cases in PWID in Athens. I propose to use SNDR for HCV in MSM in the UK. Seeds will recruit alters at risk of HCV. Each alter will complete a questionnaire about their networks and HCV risk, return a dried blood spot sample for HCV testing and then recruit further alters, creating a 'recruitment chain'. Aim: to explore current testing needs and if this new recruitment strategy of MSM recruiting peers to test for HCV is potentially acceptable, reaches those at risk who are currently not testing and could be tested in a randomised controlled trial (RCT). Participants: Any MSM aged 16+ years and newly diagnosed with HCV at the Mortimer Market Centre (SH/HIV clinic in central London) and their social and sexual contacts with a valid recruitment coupon.Plan of investigation:1. Interview MSM who do not go to SH clinics (recruited from gay saunas) and MSM who have had HCV. I will ask about testing, perception of HCV risk, disclosure of HCV diagnosis and their thoughts on the intervention e.g. number of alters approached. I will also talk to sexual health clinic staff about who they decide to test or not test for HCV and why. 2. Use the interview data to help design a questionnaire exploring HCV risk factors and social (and sexual) networks. The questionnaire will be piloted and refined with MSM. 3. Pilot the SNDR method of recruiting and testing. 4. Evaluate the data to look at the networks among MSM and the risk of hepatitis C infection.This information will provide new insight into the networks of MSM and look for other at risk groups. Participants will be given information about HCV and the results of their HCV test. I will continue to involve patients and the public in the study to make sure its findings reach the public as well as researchers and medical teams. The findings from this feasibility study can be used to plan a randomised controlled trial to determine the efficacy of this strategy. Public health benefits of this randomised controlled trial include better targeted testing and understanding of how HCV spreads.