Gender differences in hepatitis C exposure and care cascade among people who inject drugs

Author: Anna Levinsson, Nadine Kronfli, Mathieu Maheu-Giroux, Heather Valerio, Camille Zolopa, Farzaneh Vakili, Sasha Udhesister, Sarah Larney

Theme: Epidemiology & Public Health Research Year: 2023

People who inject drugs (PWID) are a critical population for achieving the World Health Organization goal of hepatitis C (HCV) elimination by 2030. Enhanced HCV prevention and treatment among PWID will simultaneously reduce clinical burden, prevalence, and incidence. We hypothesised that a gendered power structure among PWID puts women at increased risk of acquiring HCV, and at a disadvantage to benefit from current treatment enhancement strategies. To evaluate this, we conducted a systematic review of sex and gender differences in HCV exposure and care cascade among PWID.

Studies were identified in databases PubMed, Embase, and the Cochrane Database of Systematic Reviews, limited to papers published from 2012 onwards (i.e. the direct-acting antiviral [DAA] era). Sex- and gender-stratified data were extracted for indicators including needle and syringe sharing in the past six months, ever tested for HCV, initiated and completed DAA treatment respectively, and achieved sustained virologic response (SVR). Extracted data were analysed using random effects meta-analysis. 

Meta-analysis models showed that, compared to men, women are at higher risk of HCV exposure from sharing needles and syringes in the past six months (12 studies identified, risk ratio [RR] 1.15, 95% confidence interval [CI] 1.00-1.31) and are less likely to initiate DAA treatment (6 studies, RR 0.90, 95% CI 0.84-0.96). There was no statistically significant gender difference with regards to ever being tested for HCV, completing DAA treatment, or achieving SVR.  

To succeed in eliminating HCV by 2030, targeted strategies may be required, including allocating resources to improve access to harm reduction services among women who inject drugs. Work is needed to determine why women who inject drugs have lower treatment uptake than men, and to identify effective actions that address barriers to treatment uptake among women who inject drugs.

Download abstract Download poster