Women in the 2019 hepatitis C cascade of care: findings from the British Columbia Hepatitis Testers cohort study

Abstract

Background Women living with hepatitis C virus (HCV) are rarely addressed in research and may be overrepresented within key populations requiring additional support to access HCV care and treatment. We constructed the HCV care cascade among people diagnosed with HCV in British Columbia, Canada, as of 2019 to compare progress in care and treatment and to assess sex/gender gaps in HCV treatment access. Methods The BC Hepatitis Testers Cohort includes 1.7 million people who tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 2000 to 2019. Test results were linked to medical visits, hospitalizations, cancers, prescription drugs, and mortality data. Six HCV care cascade stages were identified: (1) antibody diagnosed; (2) RNA tested; (3) RNA positive; (4) genotyped; (5) initiated treatment; and (6) achieved sustained virologic response (SVR). HCV care cascade results were assessed for women, and an ‘inverse’ cascade was created to assess gaps, including not being RNA tested, genotyped, or treatment initiated, stratified by sex. Results In 2019, 52,638 people with known sex were anti-HCV positive in BC; 37% (19,522) were women. Confirmatory RNA tests were received by 86% (16,797/19,522) of anti-HCV positive women and 83% (27,353/33,116) of men. Among people who had been genotyped, 68% (6756/10,008) of women and 67% (12,640/18,828) of men initiated treatment, with 94% (5023/5364) of women and 92% (9147/9897) of men achieving SVR. Among the 3252 women and 6188 men not yet treated, higher proportions of women compared to men were born after 1975 (30% vs. 21%), had a mental health diagnosis (42% vs. 34%) and had used injection drugs (50% vs. 45%). Among 1619 women and 2780 men who had used injection drugs and were not yet treated, higher proportions of women than men used stimulants (64% vs. 57%), and opiates (67% vs. 60%). Conclusions Women and men appear to be equally engaged into the HCV care cascade; however, women with concurrent social and health conditions are being left behind. Treatment access may be improved with approaches that meet the needs of younger women, those with mental health diagnoses, and women who use drugs.

Sex‐related difference analyses of efficacy and safety in clinical trials of direct‐acting antivirals to treat chronic HCV genotype 1 and 3 infections

“…However, the difference in SVR12 rate between females and males was numerically small and not likely clinically relevant given the overall high SVR12 rates. Similar findings were seen in other studies 15,29–31 …”

“…Similar findings were seen in other studies. 15,[29][30][31] In the literature, reports of sex differences in the treatment of HCV GT3 are limited. The HCV-TARGET study 32 evaluated HCV GT 3 participants receiving sofosbuvir and ribavirin with or without peginterferon and found male sex was a negative predictor of SVR.…”

Chronic Hepatitis C and comorbidities: real-world study to evaluate impact in outcomes after treatment with sofosbuvir-based regimens

“…Female sex is known as a good predictor for spontaneous clearance among those with acute HCV infection and among those with chronic HCV. Cirrhosis progression appears to be slower in younger women (< 50 years) compared to men, with this difference abating in older women (> 50 years), possibly due to hormonal changes in menopause [27].…”

Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil

“…On the other hand, co-infection with HIV and institutionalized individuals proved to be risk factors for not undergoing treatment, and it should be noted that they are vulnerable groups[ 14 ]. The non-white race in the simple analysis also proved to be a vulnerable group for not undergoing treatment, which reminds us of the need to consider race in the implementation of public policies[ 20 ]. In the final analysis, the female sex obtained higher data in the performance of treatment; however, this data contradicts the results seen previously where women, mainly young people, tend to face barriers to engaging in any form of health care[ 21 ].…”