Theme: Epidemiology & Public Health Research Year: 2024
Background: Two community-based programs in Greece (Athens, 2018-2020 and Thessaloniki, 2019-2021) aimed to increase linkage to hepatitis C (HCV) treatment in people who inject drugs (PWID). This analysis explores whether gender differences exist in HCV prevalence and linkage to treatment.
Methods: PWID were recruited through Respondent-Driven Sampling. Participation included an interview, rapid HCV/HIV testing, additional testing for anti-HCV (+) participants and counseling. PWID with available social security number were linked to treatment with direct acting antivirals (DAAs) by the program personnel.
Results: Out of 2,734 participants, 85% (N=2,324) were men and 15% (N=410) were women. Over two-thirds (66.5%) were current PWID (past 30 days) and 21.8% were on opioid agonist treatment programs. Anti-HCV prevalence was 70.1% (95% CI: 68.4% – 71.8%), with women having higher prevalence than men (75.3% vs. 69.2%, p = 0.013). Among anti-HCV (+) participants, 16.3% reported previous HCV treatment (mostly interferon-based), with treatment uptake being marginally lower in women compared to men (15.7% vs. 20.3%, p=0.074). Prevalence of chronic HCV infection defined by detectable serum HCV RNA among anti-HCV (+) was 76.2% (95% CI: 74.0% – 78.3%), with women having significantly lower prevalence than men (69.9% vs. 77.3%, p=0.019). Across both programs, 55.3% of chronic HCV patients initiated treatment with DAAs; 50.0% and 56.2% among women and men, respectively (p=0.175). After adjusting for age, education, homelessness, ethnicity, and history of incarceration, women were marginally less likely to initiate treatment compared to men (OR=0.71; 95% CI: 0.49 – 1.03, p=0.078).
Conclusion: Our study highlighted gender disparities in the prevalence and treatment uptake of HCV infection. Although women had higher prevalence of HCV antibodies, they were less likely to have chronic HCV infection. The finding of lower HCV treatment uptake among women, compared to men, underlines the need for tailored interventions for women who inject drugs.
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