Desai M, et al. - Sexual behaviors among HIV negative men who have sex with men (MSM) who access preexposure prophylaxis (PrEP) could place them at high risk of hepatitis C virus infection (HCV). The PROUD trial of PrEP, an open‐label, wait‐list design randomized trial of HIV PrEP for MSM, was assessed for the HCV prevalence and incidence. PROUD involved recruitment of 544 participants; of these, 133 (24.4%) received HCV screening at enrollment, and 490 (90.1%) were tested at least once during follow‐up. Seroprevalence at enrolment of 2.1% (11/530) was noted. A new HCV infection was reported in 25 participants during the trial, yielding an incidence rate of 2.1 per 100 person years (PY) (25/1,188.8), of which three were re‐infections. Some evidence suggested an increasing HCV incidence over calendar time, reaching an estimated 4.0 per 100 PY in 2016. Findings thereby suggest a high and possibly increasing incidence of HCV infection in participants in PROUD. In view of the high incidence of HCV, they support the 2018 BHIVA/BASHH recommendation for quarterly HCV testing among HIV‐negative MSM using PrEP in the UK.