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Abstract Background The COVID-19 pandemic has widespread consequences for health facilities, social contacts, and health-seeking behaviour, affecting the incidence, diagnosis and reporting of other infectious diseases. We examined trends in reported chronic hepatitis C virus (HCV) infections and associated transmission routes in the Netherlands to identify the potential impact of COVID-19 on access to healthcare (testing) services. Methods We analysed notification data of patients with chronic HCV reported to the National Notifiable Disease Surveillance System from January 2019 until December 2021 in the Netherlands. Rates of newly reported chronic cases per 100,000 population with 95% confidence intervals (CI) were calculated, and we compared proportional changes in transmission routes for chronic HCV between 2019, 2020 and 2021. Results During the study period, a total of 1,521 chronic HCV infections were reported, 72% males, median age 52 years, and an overall rate of 8.8 (95%CI 8.4–9.2) per 100,000 population. We observed an overall decline (-41.9%) in the number of reported chronic HCV in 2020 compared to 2019, with the sharpest decline in men who have sex with men (MSM)-related transmission (-57.9% in 2020, p = 0.005). Conclusions Reported cases of chronic HCV strongly declined during the COVID-19 pandemic when healthcare services were scaled down. Between February and June 2021, reported chronic HCV cases increased again, indicating a recovery of healthcare services. MSM showed the largest decline compared to other groups. Further research is needed to fully understand the impact of access to healthcare, health seeking behaviour, and (sexual) transmission risks of HCV during the COVID-19 pandemic.

BackgroundThe 2022 multicountry mpox outbreaks predominantly affected gay, bisexual and other men who have sex with men (GBMSM) in non-endemic countries, including in the Netherlands. We conducted a survey-based assessment of the alignment between the risk factors associated with mpox diagnosis among GBMSM in the Netherlands and the eligibility criteria used in 2022 for vaccinating this group, with the aim to refine these criteria.MethodsAn online self-report survey was conducted among adult GBMSM in the Netherlands between 29 July and 30 August 2022, corresponding to the first month of the Dutch mpox vaccination campaign. GBMSM were recruited via advertisements on social media and gay dating apps. Participants reported on their sexual behaviour, mpox diagnosis, and/or (initial) mpox vaccination since the start of the outbreak. Covariables of mpox diagnosis and vaccination were assessed using logistic regression analyses.ResultsOf the 2,460 participants, 73 (3.0%, 95% CI 2.3–3.6%) were diagnosed with mpox and 485 (19.7%, 95% CI 18.1–21.3%) had received (initial) mpox vaccination. Using sample weighting, we estimated that, of the GBMSM population aged 18–80 years in the Netherlands, 1.1% (95% CI 0.7–1.6%) had been diagnosed with mpox and 7.8% (95% CI 6.8–8.9%) had received (initial) vaccination. HIV-PrEP use, living with HIV, reporting ≥20 sex partners in the past 12 months, and sex in sex venues/parties in the past 2 months were independent risk factors for mpox diagnosis. Except for sex in sex venues/parties, these variables were also independently associated with mpox vaccination.ConclusionThis study provides novel evidence regarding the degree to which the 2022 eligibility criteria for mpox vaccination align with the risk factors for mpox among GBMSM in the Netherlands. The findings contribute to a refinement of the eligibility criteria for mpox vaccination, to which sex in sex venues/parties should be added.

Abstract Background As highly effective therapy against hepatitis C virus (HCV) infection is available with rapid uptake, there is newfound optimism for HCV elimination. Nevertheless, certain key populations have a high risk of HCV reinfection, in particular men who have sex with men (MSM) in Western European countries. Modelling data indicate that HCV elimination will not be feasible without reduction in risk behaviour, thus supporting the need for effective interventions aimed at reducing risk behaviour and preventing reinfections in MSM. Methods The ICECREAM study is an international, multi-centred, phase 2, 3-arm randomised trial comparing run-in and intervention periods enrolling MSM with a history of a cured or spontaneously cleared HCV infection. Individuals are followed in routine care for 6 months (i.e. run-in period) and then randomly allocated (1:1:1) to one of the following: a tailored, interactive online risk-reduction behavioural intervention, a validated home-based HCV-RNA self-sampling test service using dried blood spots, or a combination of both. After randomisation, individuals are followed every 6 months until 18 months (i.e. intervention period). Interventions are delivered in addition to standard of care. Online questionnaire measuring risk behaviour over the past 6 months is administered at every visit. The primary outcome is the proportion at risk of HCV infection during run-in versus intervention periods assessed by using the HCV-MOSAIC risk score. The risk score consists of six self-reported HCV-related risk behaviours. Secondary outcomes include incidence of HCV reinfection, changes in the individual risk behaviour items and changes in sexual well-being since changes in sexual behaviour may have an impact on sexual experience. Two hundred forty-six MSM aged 18 years or older will be invited to participate. Discussion The ICECREAM study is a trial aimed at establishing interventions that could effectively decrease the incidence of HCV re-infection in MSM with a previous HCV infection. By offering an online behavioural risk-reduction intervention and HCV-RNA self-sampling, both of which are aimed to influence risk behaviour, we are able to provide products to at-risk MSM that could further reduce population-level HCV incidence and ultimately help reach HCV micro-elimination. Trial registration ClinicalTrials.gov NCT04156945. Registered on November 8, 2019

[This corrects the article DOI: 10.1371/journal.pone.0263654.].

IntroductionIn the 2022 multicountry mpox (formerly named monkeypox) outbreak, several countries offered primary preventive vaccination (PPV) to people at higher risk for infection. We study vaccine acceptance and its determinants, to target and tailor public health (communication-) strategies in the context of limited vaccine supply in the Netherlands.MethodsOnline survey in a convenience sample of gay, bisexual and other men who have sex with men, including transgender persons (22/07-05/09/2022, the Netherlands). We assessed determinants for being (un)willing to accept vaccination. We used multivariable multinominal regression and logistic regression analyses, calculating adjusted odds ratios (aOR) and 95 percent confidence-intervals. An open question asked for campaigning and procedural recommendations.ResultsOf respondents, 81.5% (n = 1,512/1,856) were willing to accept vaccination; this was 85.2% (799/938) in vaccination-eligible people and 77.7% (713/918) in those non-eligible. Determinants for non-acceptance included: urbanization (rural: aOR:2.2;1.2–3.7; low-urban: aOR:2.4;1.4–3.9; vs. high-urban), not knowing mpox-vaccinated persons (aOR:2.4;1.6–3.4), and lack of connection to gay/queer-community (aOR:2.0;1.5–2.7). Beliefs associated with acceptance were: perception of higher risk/severity of mpox, higher protection motivation, positive outcome expectations post vaccination, and perceived positive social norms regarding vaccination. Respondents recommended better accessible communication, delivered regularly and stigma-free, with facts on mpox, vaccination and procedures, and other preventive options. Also, they recommended, “vaccine provision also at non-clinic settings, discrete/anonymous options, self-registration” to be vaccinated and other inclusive vaccine-offers (e.g., also accessible to people not in existing patient-registries).ConclusionIn the public health response to the mpox outbreak, key is a broad and equitable access to information, and to low-threshold vaccination options for those at highest risk. Communication should be uniform and transparent and tailored to beliefs, and include other preventive options. Mpox vaccine willingness was high. Public health efforts may be strengthened in less urbanized areas and reach out to those who lack relevant (community) social network influences.

Summary: Background: Indicator-condition (IC) guided HIV testing is a feasible and cost-effective strategy to identify undiagnosed people living with HIV (PLHIV), but remains insufficiently implemented. We aimed to promote IC-guided HIV testing in seven ICs. Methods: Relevant departments in five hospitals of the Amsterdam region participated. HIV testing among adult patients without known HIV infection but with an IC was assessed using electronic health records during pre-intervention (January 2015–June 2020) and intervention (July 2020–June 2021) periods. The multifaceted intervention included audit and feedback. The primary endpoint was HIV testing ≤3 months before or after IC diagnosis and the effect of the intervention was evaluated using segmented Poisson regression. Findings: Data from 7986 patients were included, of whom 6730 (84·3%) were diagnosed with an IC in the pre-intervention period and 1256 (15·7%) in the intervention period. The proportion HIV tested ≤3 months before or after IC diagnosis increased from 36.8% to 47.0% (adjusted risk ratio [RR]= 1.16, 95% CI=1.03–1.30, p=0.02). For individual ICs, we observed significant increases in HIV testing among patients with cervical cancer or intraepithelial neoplasia grade 3 (adjusted RR=3.62, 95% CI=1.93–6.79) and peripheral neuropathy (adjusted RR=2.27 95% CI=1.48–3.49), but not the other ICs. Eighteen of 3068 tested patients were HIV positive (0.6%). Interpretation: Overall IC-guided testing improved after the intervention, but not for all ICs. Variations in effect by IC may have been due to variations in implemented developments, but the effect of separate elements could not be assessed. Funding: HIV Transmission Elimination Amsterdam (H-TEAM) initiative, Aidsfonds (grant number: P-42702).

Hepatitis C virus (HCV) elimination among men who have sex with men (MSM) is unlikely to be feasible without effective behavioural interventions. We developed a multilevel intervention to reduce HCV transmission among MSM in Amsterdam. The intervention includes a toolbox to facilitate risk reduction among MSM and support health care professionals in risk reduction counselling. To assess the use of the toolbox and its impact on behavior, we conducted a mixed-methods study. We collected data through online questionnaires (n = 49), and in-depth interviews with MSM at risk of HCV (n = 15) and health care professionals (n = 7). We found that the toolbox has been well received by MSM, increased awareness of HCV risks and has facilitated preventive behaviours and risk-reduction communication with peers. Professionals reported the toolbox to be a useful aid for discussions about HCV risk and risk reduction strategies with their clients.

BackgroundIn the Netherlands, transmission of hepatitis C virus (HCV) occurs primarily among men who have sex with men (MSM). Early HCV testing of at-risk MSM and immediate initiation of treatment will prevent onward transmission, but this may not be sufficient to eliminate HCV in a population with ongoing risk behaviors. Therefore, targeted socioculturally acceptable preventive measures, including behavioral interventions, are urgently needed. Currently, little contextually appropriate information about HCV or risk reduction interventions is available. ObjectiveThe objective of this project was to develop an intervention to reduce HCV transmission among MSM in Amsterdam through a co-creation process, with the input of men from the targeted community directly impacting intervention content, design, and implementation. MethodsWe developed a multilevel intervention targeting 6 levels: individual, community, professional, context, patient, and network. The intervention was developed in close cooperation between health professionals, gay community members, commercial stakeholders, and stakeholders from within the gay community. The co-creation process had 4 phases: a needs assessment, stakeholder engagement, co-creation, and implementation. The co-creation phase continued until consensus was reached between the researchers and community members on the intervention content and design. The final intervention, NoMoreC, was completed within 2 years, and implementation started in February 2018. ResultsNoMoreC includes web-based and face-to-face components as well as an anonymous HCV testing service. The NoMoreC website provides information about hepatitis C, HCV transmission routes, risk reduction strategies, testing and treatment options, and partner notification. The face-to-face component comprises a risk reduction toolbox, training for health professionals, and providing tailored advice to sex on premises venues. NoMoreC is promoted by an active voluntary campaign team. ConclusionsInvolving the community and stakeholders in the creation of NoMoreC has been the main strength of this project. It has resulted in an intervention with various components that resonates with the gay community at risk of HCV infection. The uptake and acceptability of the described intervention will be evaluated in the future. The description of the co-creation process and implementation of the project may serve as a rich and useful source for others who want to develop culturally and context appropriate HCV interventions.

The three large towns of Holland, Amsterdam, The Hague and Rotterdam, each had their own building trade by the end of the 18th century. The Amsterdam building trade was the largest and had much impact on the surrounding area. Amsterdam master builders were called in there and citizens of Amsterdam were in charge in the countryside. In The Hague it was particularly the administrative circles that were fond of representation, but their home grounds were far away, so that their buildings in the countryside did not resemble their houses in town. Rotterdam was a young town, surrounded by more important towns, such as Dordrecht, Delft and Gouda. It was not until the 17th century that it outgrew them, but it retained a primitive building trade with designing building contractors for a long time. Only for very special buildings was the service of a real architect from outside called in, who designed exclusively and supervised the execution. In such situations, Rotterdam and Gouda availed themselves of the services of The Hague architect Pieter de Swart. His death in 1773 paved the way for the young draughtsman of Italian descent, Carlo Giovanni Francesco Giudici (1746-1819). The energetic stone trader George Elgin from Scotland, who had settled in Rotterdam in 1754, must have discovered Giudici as draughtsman and assistant around 1770. Gradually Giudici also obtained a few commissions for the town and after 1778 a regular association with the Admiralty. Much of his work was lost, due to town extension and the bombing of Rotterdam in 1940. Especially the unexecuted designs are important, such as an entry for the competition for the Groningen Town Hall (1775) and a plan for the Rotterdam Town Hall (1781). These had been designed in a somewhat international style with a clear English slant to them, such as open columnal portico's, horizontal wall bands between the floors, fanciful spires and tripartite division of glass panes in the windows. Only a few important works have been preserved outside Rotterdam, such as two large buildings in Schiedam and some buildings in Leiden after the gunpowder explosion of 1807. No Italian, nor French influence is to be recognized in his work.

Among the many large town fires in the 16th century the fire of Delft in 1536 was the most extensive. The extent of this disaster is to be compared to a large bombing during the last World War. A lot of the rebuilt houses still exist, some even with the old facades. Four drawings from around 1785 of disappeared facades complete the picture and gave rise to this article (ill. 4. 10-12). After the fire the walls of churches and monasteries largely survived and the wooden roofs and vaults could be restored. The houses needed total renewal. There is not much evidence of guidance in this matter by the town council. Building regulations were temporarily suspended, but the use of joint walls was promoted, which saved brick and made the houses more spacious. After the disaster the Delft building trade had plenty of work clearing the rubble and carrying out emergency restorations for several years. Rich people were able to employ a building contractor from outside the town. This led to new types of facades with freer compositions. All known contacts were made through Dordrecht, which as the major commercial town maintained the relations with the Southern Netherlands. A lot of sculpture on the Delft facades also appears to be of Dordrecht origin. The new styles must have been imported along this route. (ill. 2, 3. 4. 5). In the retinue of this vanguard forms of facades were built that suited the various groups of commissioners (ill. 4-9). In cooperation with Dordrecht contractors new variations of facades were realised, applied by the latter in the entire working space of the southern Netherlands. Due to the division of the northern and southern Netherlands after 1600 Dordrecht lost its prominent position to Amsterdam. Delft reverted to a simple country town again. Just as Dordrecht it was one of the few Dutch towns that did not expand during the 17th century. The aftermath of the important Delft-Dordrecht period in the 16th century left its traces throughout the southwest Netherlands (ill. 11-12). Without an insight into the far-reaching consequences of a town fire it is impossible to understand why these prestige objects are found here.

Een tekenboekje uit 1812 en 19de-eeuwse huisplattegronden The 'drawing book' from 1812 was compiled by the building contractor and architect Johannes van Straaten (1781-1856). He exerted himself for the education of young building engineers. The booklet provided training in contract drawing, which concerned the very precise drawings belonging to building specifications. As examples Van Straaten designed a few modern houses. Since not much was built in those days, these examples are important. The booklet contains two kinds of examples, the first being a group of four civilian houses, the second three large houses for the rich. Only the former group of four is dealt with here, forming a coherent series of simple to more luxurious houses. The façades are modern, the floor plans still show the old-fashioned layout with three successive rooms. However, they are provided with modern elements such as doublé doors (porte-brisé) between rooms and alcove niches for beds. The most important aspect was the change in the form of staircases. The staircases were now placed against the side wall, with the corridors running between the staircase and the rooms. The front and back rooms were equally wide and connected en suite. This new form of staircase proved to be suitable for complete houses as well as for flats and left its mark on 19th century housing.

In the beginning of the Dutch war of independence (1568-1648) it was particularly the countryside that suffered. When around 1590 many towns had obtained a new confirmation, the attention for architecture revived again (ill. 1-5). The ornamental roof played an important part in this. It originated in around 1550 by a clear separation between roof and facade by means of a gutter board. The place of the chimney was also given more attention. For a long time building in the countryside proceeded cautiously, in small parts. Consequently, the reconstruction of country houses was not a major chapter in Dutch history of architecture, which had taken cover in the towns. Restoration in the countryside did not start until 1609, when a truce with Spain was concluded. After this truce the nobility, who had fled to the south, were able to sell their confiscated property. For the greater part this property passed into the hands of townsmen, who preferred country houses to castles. In the first phase of restoration, building was modest and improvised (ill. 6, 7). Often in various successive campaigns. For that reason, the facades remained old fashioned. In the last phase a fashionable ornamental roof was often applied (ill. 9-11). A project which took a central place in this was the Huis te Capelle, which rose again in 1610 and was completely refurbished in 1617 (ill. 12-16). The culmination of this new form of country houses with ornamental roofs was the first wing of the castle Honselaarsdijk, built by order of Frederik Hendrik (ill. 17). In that same year the war against Spain was resumed, which tempered the desire to build large country houses again (ill. 18). After the situation had become safer around 1635, the masterpieces from the period of the Truce were reverted to again in new projects (ill. 19-23), although the details were simplified. The great and successful models of the country houses with ornamental roofs lived on in imitations of their main form or of components. They were a welcome change in severe Dutch Classicism.

The approximately ten houses preserved along the Haringvliet after 1940, provide an insight into the development of Rotterdam merchant houses. This unique type of house was built because of local conditions. As a result of the soft building land and high flood tides the warehouse was downstairs and the living space upstairs in these houses. Thus the weight of the goods was divided over the floors and the walls were less burdened. The joint walls prescribed here made complete rebuilding of the houses almost impossible. Their history consisted in minor and major conversions. Because the street was raised by a total of nearly two metres, the inner height of the warehouses was diminished, so that the facades had to be renovated several times. Around 1675 the first floor of these expensive houses became a favourite project. This floor could only be constructed above the warehouse and covered the entire depth of the house. A frequently used lay-out was developed, with a light well in the middle and two large rooms both in the front and the back part of the house. On each of the exterior walls there was a hall, and on both sides of the light well a large room. In both parts of the house there were staircases, of which the one in the back part was most important. In the light well there was a low connecting room deriving its name from the crowning lantern. On one side there was a hallway with stucco vaults, in many cases extending up to the façade, from where the light flowed in. This hallway was connected to the front door by a monumental, little-used staircase. The domestic rooms were accommodated in the back part under the first floor. The entrance to these rooms was through the warehouse. Gradually the household began to require more space, just as the merchant's administration. Around 1700 the warehouse was abandoned in the larger houses and replaced by a room on the street side with one or two windows next to the monumental front door. Only one entrance was left in these large houses, which was used by everyone alike. Consequently, along the harbours two types of houses were to be found, the traditional one with a warehouse downstairs and the more modern type with a domestic ground floor. A design for a contest dating from 1860 proposes a similar house, on a site that is strongly reminiscent of the house along the Haringvliet. It is the final stage in the development that took place along the Haringvliet. The houses built in the new districts a few years later, were smaller and more practical. The new functions. such as office space and household facilities could no longer be accommodated within the walls of the houses.

Cerium oxide nanoparticles (CeO2 NPs) are used as diesel fuel additives to catalyze oxidation. Phenanthrene is a major component of diesel exhaust particles and one of the most common pollutants in the environment. This study aimed at determining the effect of CeO2 NPs on the toxicity of phenanthrene in Lufa 2.2 standard soil for the isopod Porcellionides pruinosus and the springtail Folsomia candida . Toxicity tests were performed in the presence of CeO2 concentrations of 10, 100 or 1000 mg Ce/kg dry soil and compared with results in the absence of CeO2 NPs. CeO2 NPs had no adverse effects on isopod survival and growth or springtail survival and reproduction. For the isopods, LC50s for the effect of phenanthrene ranged from 110 to 143 mg/kg dry soil, and EC50s from 17.6 to 31.6 mg/kg dry soil. For the springtails, LC50s ranged between 61.5 and 88.3 mg/kg dry soil and EC50s from 52.2 to 76.7 mg/kg dry soil. From this study it may be concluded that CeO2 NPs have a low toxicity and do not affect toxicity of phenanthrene to isopods and springtails. [ABSTRACT FROM AUTHOR]

Background: The 2022 multicountry mpox outbreaks predominantly affected gay, bisexual and other men who have sex with men (GBMSM) in non-endemic countries, including in the Netherlands. We conducted a survey-based assessment of the alignment between the risk factors associated with mpox diagnosis among GBMSM in the Netherlands and the eligibility criteria used in 2022 for vaccinating this group, with the aim to refine these criteria., Methods: An online self-report survey was conducted among adult GBMSM in the Netherlands between 29 July and 30 August 2022, corresponding to the first month of the Dutch mpox vaccination campaign. GBMSM were recruited via advertisements on social media and gay dating apps. Participants reported on their sexual behaviour, mpox diagnosis, and/or (initial) mpox vaccination since the start of the outbreak. Covariables of mpox diagnosis and vaccination were assessed using logistic regression analyses., Results: Of the 2,460 participants, 73 (3.0%, 95% CI 2.3-3.6%) were diagnosed with mpox and 485 (19.7%, 95% CI 18.1-21.3%) had received (initial) mpox vaccination. Using sample weighting, we estimated that, of the GBMSM population aged 18-80 years in the Netherlands, 1.1% (95% CI 0.7-1.6%) had been diagnosed with mpox and 7.8% (95% CI 6.8-8.9%) had received (initial) vaccination. HIV-PrEP use, living with HIV, reporting ≥20 sex partners in the past 12 months, and sex in sex venues/parties in the past 2 months were independent risk factors for mpox diagnosis. Except for sex in sex venues/parties, these variables were also independently associated with mpox vaccination., Conclusion: This study provides novel evidence regarding the degree to which the 2022 eligibility criteria for mpox vaccination align with the risk factors for mpox among GBMSM in the Netherlands. The findings contribute to a refinement of the eligibility criteria for mpox vaccination, to which sex in sex venues/parties should be added., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Adam, Op de Coul, Zantkuijl, Xiridou, Bos, Blom, Ketsuwan, te Wierik, David and de Wit.)

Introduction: In the 2022 multicountry mpox (formerly named monkeypox) outbreak, several countries offered primary preventive vaccination (PPV) to people at higher risk for infection. We study vaccine acceptance and its determinants, to target and tailor public health (communication-) strategies in the context of limited vaccine supply in the Netherlands., Methods: Online survey in a convenience sample of gay, bisexual and other men who have sex with men, including transgender persons (22/07-05/09/2022, the Netherlands). We assessed determinants for being (un)willing to accept vaccination. We used multivariable multinominal regression and logistic regression analyses, calculating adjusted odds ratios (aOR) and 95 percent confidence-intervals. An open question asked for campaigning and procedural recommendations., Results: Of respondents, 81.5% ( n = 1,512/1,856) were willing to accept vaccination; this was 85.2% (799/938) in vaccination-eligible people and 77.7% (713/918) in those non-eligible. Determinants for non-acceptance included: urbanization (rural: aOR:2.2;1.2-3.7; low-urban: aOR:2.4;1.4-3.9; vs. high-urban), not knowing mpox-vaccinated persons (aOR:2.4;1.6-3.4), and lack of connection to gay/queer-community (aOR:2.0;1.5-2.7). Beliefs associated with acceptance were: perception of higher risk/severity of mpox, higher protection motivation, positive outcome expectations post vaccination, and perceived positive social norms regarding vaccination. Respondents recommended better accessible communication, delivered regularly and stigma-free, with facts on mpox, vaccination and procedures, and other preventive options. Also, they recommended, "vaccine provision also at non-clinic settings, discrete/anonymous options, self-registration" to be vaccinated and other inclusive vaccine-offers (e.g., also accessible to people not in existing patient-registries)., Conclusion: In the public health response to the mpox outbreak, key is a broad and equitable access to information, and to low-threshold vaccination options for those at highest risk. Communication should be uniform and transparent and tailored to beliefs, and include other preventive options. Mpox vaccine willingness was high. Public health efforts may be strengthened in less urbanized areas and reach out to those who lack relevant (community) social network influences., Competing Interests: PZ was employed by Soa Aids Nederland. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Dukers-Muijrers, Evers, Widdershoven, Davidovich, Adam, Op de Coul, Zantkuijl, Matser, Prins, de Vries, Heijer, Hoebe, Niekamp, Schneider, Reyes-Urueña, Croci, D'Ambrosio, Valk, Posthouwer, Ackens, Waarbeek, Noori and Hoornenborg.)

In the Netherlands, hepatitis C virus (HCV) transmission occurs primarily in men who have sex with men (MSM). By early diagnosis and immediate treatment of acute HCV infections, HCV micro-elimination in MSM is within reach. In cooperation with the community affected, we developed an online HCV-RNA home-based self-sampling test service. This service combined online HCV self-risk assessment with the possibility to test anonymously for HCV-RNA. The service was available in the Netherlands from February 2018 till December 2020 and was promoted online on various dating sites and offline by community volunteers. Using website user data, test results and an online post-test user survey, we evaluated the service and user experiences. The website page with information about testing was visited by 3401 unique users, of whom 2250 used the HCV-risk assessment tool, 152 individuals purchased 194 HCV-RNA tests, and 104 tests were used, of which 101 gave a conclusive result. The target population of MSM at risk was successfully reached with 44.1% of users receiving the advice to test. The test service had a satisfactory uptake (6.8%, 152/2250), a very high HCV-RNA positivity rate (10.9%, 11/101) and was considered acceptable and easy to use by most MSM. We demonstrate that an HCV-RNA home-based self-sampling test service is successful in diagnosing HCV infections among MSM. This service could be a valuable addition to existing sexual healthcare services as it may reach men who are otherwise not tested., (© 2022 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd.)

Hepatitis C virus (HCV) elimination among men who have sex with men (MSM) is unlikely to be feasible without effective behavioural interventions. We developed a multilevel intervention to reduce HCV transmission among MSM in Amsterdam. The intervention includes a toolbox to facilitate risk reduction among MSM and support health care professionals in risk reduction counselling. To assess the use of the toolbox and its impact on behavior, we conducted a mixed-methods study. We collected data through online questionnaires (n = 49), and in-depth interviews with MSM at risk of HCV (n = 15) and health care professionals (n = 7). We found that the toolbox has been well received by MSM, increased awareness of HCV risks and has facilitated preventive behaviours and risk-reduction communication with peers. Professionals reported the toolbox to be a useful aid for discussions about HCV risk and risk reduction strategies with their clients., Competing Interests: The authors have declared that no competing interests exit.