Background. Since 2000, incidence of sexually acquired hepatitis C virus (HCV)-infection has increased among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). To date, few case-control and cohort studies evaluating HCV transmission risk factors were conducted in this population, and most of these studies were initially designed to study HIV-related risk behavior and characteristics.Methods. From 2009 onwards, HIV-infected MSM with acute HCV infection and controls (HIV-monoinfected MSM) were prospectively included in the MOSAIC (MSM Observational Study of Acute Infection with hepatitis C) study at 5 large HIV outpatient clinics in the Netherlands. Written questionnaires were administered, covering sociodemographics, bloodborne risk factors for HCV infection, sexual behavior, and drug use. Clinical data were acquired through linkage with databases from the Dutch HIV Monitoring Foundation. For this study, determinants of HCV acquisition collected at the inclusion visit were analyzed using logistic regression.Results. Two hundred thirteen HIV-infected MSM (82 MSM with acute HCV infection and 131 MSM without) were included with a median age of 45.7 years (interquartile range [IQR], 41.0–52.2). Receptive unprotected anal intercourse (adjusted odds ratio [aOR], 5.01; 95% confidence interval [CI], 1.63–15.4), sharing sex toys (aOR, 3.62; 95% CI, 1.04–12.5), unprotected fisting (aOR, 2.57; 95% CI, 1.02–6.44), injecting drugs (aOR, 15.62; 95% CI, 1.27–192.6), sharing straws when snorting drugs (aOR, 3.40; 95% CI, 1.39–8.32), lower CD4 cell count (aOR, 1.75 per cubic root; 95% CI, 1.19–2.58), and recent diagnosis of ulcerative sexually transmitted infection (aOR, 4.82; 95% CI, 1.60–14.53) had significant effects on HCV acquisition.Conclusions. In this study, both sexual behavior and biological factors appear to independently increase the risk of HCV acquisition among HIV-infected MSM.

BackgroundAmong HIV-infected MSM who have been treated for HCV infection, the HCV reinfection rate is high. It is therefore essential to understand their perceptions of HCV risk behaviour and risk-reducing strategies.MethodsThis qualitative study among 20 HCV-infected MSM, the majority treated in the era before direct acting antivirals, provides insight into their ideas, motives, and barriers concerning HCV risk reduction, and aims to strengthen prevention strategies for both primary HCV infection and HCV reinfection.ResultsThe strongest motive to implement risk reduction strategies was the reward of avoiding HCV retreatment and its side effects, but this may change with the current implementation of less burdensome HCV treatment. Also, the sexual risk norms in the MSM scene, including social pressure towards risk-taking, HCV stigma, and non-disclosure of HCV status, all form barriers to safe sex. Drug use, strongly present in the context of clubs and group sex, directly impedes the self-efficacy of men to take risk reduction measures.ConclusionsTailored prevention messages, empowerment of self-efficacy for risk reduction, and more insight into risk behaviour over time are ingredients for effective HCV prevention among these men.

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BackgroundAntimicrobial resistance (AMR) increasingly threatens public health. Carbapenem-producing gram-negative bacteria (CPB) pose the biggest threat. The risk for CPB spread is heightened during the transfer of a CPB-positive patient between different healthcare institutions or healthcare providers. We aimed to gain insight into the frequency of CPB-positive patients in the Dutch provinces of Noord-Holland (NH) and Flevoland (FL). Secondly, we aimed to obtain a deeper understanding of the communication between healthcare providers during transfers of CPB-positive patients and explore possible communication-related risk situations for CPB spread.MethodsThis mixed-methods study consisted of a quantitative and qualitative section. For the quantitative section, 14 laboratories that provide diagnostics in NH and FL voluntarily reported carbapenem-producing Enterobacteriaceae (CPE) positive patients between February 2018 and February 2019. Additionally, two laboratories reported carbapenem-resistant Acinetobacter spp. (CRA) and carbapenem-resistant Pseudomonas aeruginosa (CRP) positive patients. For the qualitative section, healthcare providers of reported patients were interviewed about information exchange during patient transfers, precautionary measures and knowledge and beliefs concerning CPB.ResultsIn total, 50 CPE-positive, 10 CRA-positive and 4 CRP-positive patients were reported during the inclusion period. Eighteen index-specific and 2 general interviews were conducted with 20 different care providers of 9 patients. The interviews revealed that, in most cases, information concerning the patient was transferred timely, but often a standardized method for sharing the information within and between institutions was lacking. Factors that enhanced care providers’ motivation to adhere to precautionary measures were taking responsibility for the health of other patients, (pregnant) colleagues and for ones own health. Factors that reduced motivation were not acknowledging the relevance of the precautionary measures, a perceived negative impact of the measures on patients’ recovery, differences in precautionary measures between healthcare settings and incomprehension for changes in precautionary measures.ConclusionsCPB-positivity occurred more frequently than expected in the Dutch provinces of NH and FL. Standardizing the transference of information concerning CPB-positive patients, implementing transmural agreements, training personnel on CPB knowledge and procedures, launching a national website on CPB and assigning one or several designated employees for CPB within healthcare institutions could improve communication between healthcare providers and thereby decrease the risk of CPB transmission.

After publication of the original article [1], we have noticed that the word 'Carbapenem-producing' should be replaced with 'Carbapenemase-producing'.