Sex and gender differences in hepatitis C virus risk, prevention, and cascade of care in people who inject drugs: systematic review and meta-analysis

Anna Levinsson; Camille Zolopa; Farzaneh Vakili; Sasha Udhesister; Nadine Kronfli; Mathieu Maheu-Giroux; Julie Bruneau; Heather Valerio; Sahar Bajis; Phillip Read; Elisa Martró; Lisa Boucher; Leith Morris; Jason Grebely; Adelina Artenie; Jack Stone; Peter Vickerman; Sarah Larney

doi:10.1016/j.eclinm.2024.102596

Sex and gender differences in hepatitis C virus risk, prevention, and cascade of care in people who inject drugs: systematic review and meta-analysis

EClinicalMedicine. 2024 Apr 10:72:102596. doi: 10.1016/j.eclinm.2024.102596. eCollection 2024 Jun.

Authors

Anna Levinsson^{1

2

3}, Camille Zolopa^{1

4}, Farzaneh Vakili^{1

5}, Sasha Udhesister^{1

5}, Nadine Kronfli^{6

7}, Mathieu Maheu-Giroux², Julie Bruneau^{1

5}, Heather Valerio⁸, Sahar Bajis⁸, Phillip Read⁹, Elisa Martró^{10

11}, Lisa Boucher¹², Leith Morris¹³, Jason Grebely⁸, Adelina Artenie¹⁴, Jack Stone¹⁴, Peter Vickerman^{14

15}, Sarah Larney^{1

5

16}

Affiliations

¹ Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
² Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Québec, Canada.
³ School of Public Health and Community Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
⁴ Department of Educational & Counselling Psychology, McGill University, Montréal, Québec, Canada.
⁵ Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada.
⁶ Division of Infectious Disease and Chronic Viral Illness Service, Department of Medicine, McGill University, Montréal, Québec, Canada.
⁷ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
⁸ The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
⁹ Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
¹⁰ Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain.
¹¹ Biomedical Research Networking Center in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
¹² Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹³ School of Public Health, Faculty of Medicine, Univerity of Queensland, Brisbane, Australia.
¹⁴ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
¹⁵ NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, United Kingdom.
¹⁶ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Abstract

Background: People who inject drugs (PWID) are a priority population in HCV elimination programming. Overcoming sex and gender disparities in HCV risk, prevention, and the cascade of care is likely to be important to achieving this goal, but these have not yet been comprehensively reviewed.

Methods: Systematic review and meta-analysis. We searched Pubmed, EMBASE and the Cochrane Database of Systematic Reviews 1 January 2012-22 January 2024 for studies of any design reporting sex or gender differences among PWID in at least one of: sharing of needles and/or syringes, incarceration history, injection while incarcerated, participation in opioid agonist treatment or needle and syringe programs, HCV testing, spontaneous HCV clearance, direct-acting antiviral (DAA) treatment initiation or completion, and sustained virological response (SVR). Assessment of study quality was based on selected aspects of study design. Additional data were requested from study authors. Data were extracted in duplicate and meta-analysed using random effects models. PROSPERO registration CRD42022342806.

Findings: 9533 studies were identified and 92 studies were included. Compared to men, women were at greater risk for receptive needle and syringe sharing (past 6-12 months: risk ratio (RR) 1.12; 95% confidence interval (CI) 1.01-1.23; <6 months: RR 1.38; 95% CI 1.09-1.76), less likely to be incarcerated (lifetime RR 0.64; 95% CI 0.57-0.73) more likely to be tested for HCV infection (lifetime RR 1.07; 95% CI 1.01, 1.14), more likely to spontaneously clear infection (RR1.58; 95% CI 1.40-1.79), less likely to initiate DAA treatment (0.84; 95% CI 0.78-0.90), and more likely to attain SVR after completing DAA treatment (RR 1.02; 95% CI 1.01-1.04).

Interpretation: There are important differences in HCV risk and cascade of care indicators among people who inject drugs that may impact the effectiveness of prevention and treatment programming. Developing and assessing the effectiveness of gender-specific and gender-responsive HCV interventions should be a priority in elimination programming.

Funding: Réseau SIDA-MI du Québec.

Keywords: Hepatitis C virus; People who inject drugs; Sex and gender differences.

Grants and funding

WT_/Wellcome Trust/United Kingdom