Lower HCV treatment uptake in women who have received opioid agonist therapy before and during the DAA era: The ANRS FANTASIO project

• Published in: The International journal of drug policy Vol. 72; pp. 61 - 68
• Main Authors: Rojas Rojas, Teresa, Di Beo, Vincent, Delorme, Jessica, Barre, Tangui, Mathurin, Philippe, Protopopescu, Camelia, Bailly, François, Coste, Marion, Authier, Nicolas, Carrieri, Maria Patrizia, Rolland, Benjamin, Marcellin, Fabienne
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.10.2019; Elsevier Science Ltd; Elsevier
• Subjects: Adult; Antiviral Agents - administration & dosage; Antiviral drugs; Barrier to care; Databases, Factual; Delivery of Health Care - organization & administration; Direct acting antivirals; Discrimination; Drug policy; Female; France; Health care; Health Services Accessibility; Healthcare Disparities - statistics & numerical data; Hepatitis; Hepatitis C; Hepatitis C virus; Hepatitis C, Chronic - drug therapy; Human health and pathology; Humans; Hépatology and Gastroenterology; Infections; Interferon; Interferons - administration & dosage; Life Sciences; Male; Marginality; Medical treatment; Methadone; Middle Aged; Narcotics; Opioid agonist therapy; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - therapy; Opioids; Pegylated interferon; Prevention; Primary care; Primary Health Care - organization & administration; Prisoners; Santé publique et épidémiologie; Sex Factors; Sexism; Stigma; Substance abuse treatment; Uptake; Women; France; Women; Direct acting antivirals; Opioid agonist therapy; Hepatitis C virus; Pegylated interferon; Barrier to care
• DOI: 10.1016/j.drugpo.2019.05.013
• ISSN: 0955-3959

[Display omitted] In the era of direct-acting antivirals (DAA) for the treatment of hepatitis C virus (HCV) infection, HCV treatment uptake remains insufficiently documented in key populations such as people with opioid dependence. Access to opioid agonist therapy (OAT) is facilitated in France through delivery in primary care, and individuals with opioid dependence can be identified as those receiving OAT. Women with opioid dependence are especially vulnerable because of associated sex-related stigma, discrimination, and marginalization, all of which negatively interfere with access to HCV prevention and care. This study, based on data collected between 2012 and 2016 in France, aimed to assess whether (i) chronically HCV-infected women with opioid dependence had lower rates of HCV treatment uptake than their male counterparts during the same period (i.e., study period), and (ii) the advent of DAA resulted in increased treatment uptake rates in these women. Individuals with opioid dependence were identified as those receiving OAT at least once during the study period. Analyses were based on exhaustive anonymous care delivery data from the French national healthcare reimbursement database. We used multinomial logistic regression to estimate sex-based disparities in HCV treatment uptake (DAA or pegylated-interferon (Peg-IFN)-based treatment versus no treatment) while accounting for potential confounders. The study sample comprised 27,127 individuals, including 5640 (20.8%) women. Median [interquartile range] age was 45 [40–49] years. Between 2012 and 2016, 70.9 (women: 77.2; men: 69.3), 17.3 (14.2; 18.2) and 11.7% (8.6%; 12.5%) of the study sample received, respectively, no HCV treatment, DAA and Peg-IFN-based treatment only. After multiple adjustment for potential confounders, women were 41% (adjusted odds-ratio (AOR) [95% confidence interval (CI]): 0.59[0.53−0.65]) and 28% (0.72[0.66−0.78]) less likely than men to have had Peg-IFN-based and DAA treatment, respectively. Despite increased HCV treatment uptake in women with opioid dependence in the DAA era, rates remain lower than for men. In the coming years, access to DAA treatment will continue to increase in France thanks to a forthcoming simplified model of HCV care which includes primary care as an entry point. Nevertheless, a greater understanding of sex-specific barriers to HCV care and the implementation of appropriate sex-specific measures remain a priority.