The impact of the COVID-19 and mpox outbreaks on behaviours associated with HCV infection among MSM: results from the prerandomisation phase of a clinical trial

Objective:To assess whether the COVID-19 and mpox outbreaks affected hepatitis C virus (HCV) related behaviours among men who have sex with men (MSM) with a cleared HCV infection.Design:Longitudinal analysis from the international ICECREAM trial (2021-2024).Methods:During the prerandomisation phase (i.e., without any intervention) individuals completed questionnaires on sexual and drug use behaviours and whether the COVID-19 (since start trial) or mpox (shortly after the mpox outbreak in 2022) outbreaks caused changes in these behaviours, all referring to the preceding 6 months. We used mixed-effects logistic regression to model changes in behaviours due to COVID-19 or mpox measures and mixed-effects linear regression to model the average HCV-MOSAIC risk score, as a proxy of HCV-associated risk behaviour, over calendar time.Results:220 MSM (n = 117 from the Netherlands, n = 103 from France) were included. Among 208 that completed the baseline questionnaire, 171 (82.2%) were MSM with HIV. The proportion of individuals reporting any impact of COVID-19 restrictions on risk behaviours, mainly lowering number of partners, decreased from 74.7% in September 2021 to 6.7% in September 2024 (P < 0.001) and reporting any impact of mpox from 41.9% in November 2022 to 6.0% in September 2024 (P = 0.001). The average HCV-MOSAIC risk score remained constant over time (P = 0.59) and was consistently ≥2.0, indicating high reinfection susceptibility.Conclusion:HCV-related behaviours decreased when COVID-19 and mpox measures were in place. However, individuals still engaged in behaviours associated with HCV, highlighting the importance of continued sexual health services and prevention efforts during such outbreaks.