Heather is a postdoctoral researcher at the Viral Hepatitis Clinical Research Program at the Kirby Institute, UNSW Sydney.

Background: Evaluating gender-specific trends in hepatitis C virus (HCV) treatment uptake among men and women who inject drugs is crucial for monitoring and ensuring equitable progress towards elimination. This study aimed to quantify the difference in treatment uptake between men and women who inject drugs and to evaluate the factors associated with treatment among women who inject drugs, specifically, as they face additional barriers to care compared to men.

Method: ETHOS Engage is an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire including self-reported HCV treatment history and underwent point-of-care HCV RNA testing (Xpert® HCV Viral Load Fingerstick). We evaluated HCV treatment, self-reported during recruitment waves 1 (May 2018-September 2019) and 2 (November 2019-April 2021). Logistic regression was used to compare self-reported HCV treatment between men and women and to identify factors associated with women.

Results: Among 2,395 participants enrolled in ETHOS Engage, 66% (n=1,591) identified as men, 33% (n=786) identified as women, and <1% (n=18) neither. Among those with evidence of previous or current HCV infection, women were less likely to report a history of HCV treatment compared to men (227/352, 64% vs. 631/890, 71%; adjusted odds ratio [aOR]: 0.74, 95% confidence interval [CI]: 0.56, 0.99). Among women, treatment was higher among those >45 years (aOR: 2.12, 95%CI: 1.30, 3.46), those currently receiving opioid agonist treatment (vs. never, aOR: 2.38, 95%CI: 1.03, 5.49) and those recruited in recruitment wave 2 (aOR: 1.99, 95%CI: 1.18, 3.35).

Conclusion: Although HCV treatment was more likely in the second wave of recruitment among women, gender-disparities persist. Overall, women were less likely to report HCV treatment compared to men, with women who have never received opioid agonist treatment, and women of childbearing age (<45) remaining priority populations for engagement with HCV care.