Individual and structural factors associated with recent hepatitis C testing in people who inject drugs: gender-based analyses of the Cosinus Cohort

Background: People who inject drugs (PWID) are particularly affected by hepatitis C virus (HCV) and face individual and structural barriers limiting HCV care access. Women present specific vulnerabilities. We aimed to identify factors associated with recent HCV testing in PWID according to gender.

Methods: We used data from the French Cosinus cohort (Cohorte pour l’évaluation des facteurs Structurels et Individuels de l’USage de drogues) (n=665) conducted in 2016-2019. Specifically, we selected data for 298 (i.e., 624 observations) PWID attending harm reduction (HR) facilities in two cities (Marseille, Bordeaux) participating in Cosinus. Only the inclusion, 6-month, and 12-month visits were analyzed. We performed multivariable mixed logistic regression stratified for gender.

Results: At inclusion, 79% (n=235) of participants were men and 21% (n=63) women. For men, factors positively associated with recent testing for HCV were prison experience (adjusted odds ratios (aOR) [95% confidence interval (CI)]: 3.42 [1.37,8.52], p=0.008), attending a HR facility (aOR [95% CI]: 2.51 [1.44,4.38], p=0.001), and lifetime suicide attempt (aOR [95% CI]: 2.03 [1.08,3.80], p=0.028). Older men were less likely (aOR [95% CI]: 0.95 [0.92,0.99], p=0.006) to have been recently tested. For women, those employed (aOR [95% CI]: 0.39 [0.16,0.99], p=0.047) were less likely to have been recently tested than those unemployed. Furthermore, women who had slept rough in the previous month (aOR [95% CI]: 4.22 [1.36,13.12], p=0.013) were more likely to have been tested than those not sleeping rough.

Conclusion: Our results highlight different HCV testing factors for men and women who inject drugs. Although men attending HR facilities were, in general, more likely to be tested for HCV, this was not the case for older men. For women, access to HR facilities was not associated with HCV testing. These results confirm the importance of adapting HR services to PWID, and paying special attention to women’s needs.