Hepatitis C Care Cascades for 3 Populations at High Risk: Low-income Trans Women, Young People Who Inject Drugs, and Men Who Have Sex With Men and Inject Drugs

Abstract

Background: To achieve elimination of hepatitis C virus (HCV) infection, limited resources can be best allocated through estimation of "care cascades" among groups disproportionately affected. In San Francisco and elsewhere, these groups include young (age ≤ 30 years) people who inject drugs (YPWID), men who have sex with men who inject drugs (MSM-IDU), and low-income trans women.

Methods: We developed cross-sectional HCV care cascades for YPWID, MSM-IDU, and trans women using diverse data sources. Population sizes were estimated using an inverse variance-weighted average of estimates from the peer-reviewed literature between 2013 and 2019. Proportions of past/current HCV infection, diagnosed infection, treatment initiation, and evidence of cure (sustained virologic response at 12 weeks posttreatment) were estimated from the literature using data from 7 programs and studies in San Francisco between 2015 and 2020.

Results: The estimated number of YPWID in San Francisco was 3748; 58.4% had past/current HCV infection, of whom 66.4% were diagnosed with current infection, 9.1% had initiated treatment, and 50% had confirmed cure. The corresponding figures for the 8135 estimated MSM-IDU were: 29.4% with past/current HCV infection, 70.3% diagnosed with current infection, 28.4% initiated treatment, and 38.9% with confirmed cure. For the estimated 951 low-income trans women, 24.8% had past/current HCV infection, 68.9% were diagnosed with current infection, 56.5% initiated treatment, and 75.5% had confirmed cure.

Conclusions: In all 3 populations, diagnosis rates were relatively high; however, attention is needed to urgently increase treatment initiation in all groups, with a particular unmet need among YPWID.

Keywords: MSM; PWID; care cascade; hepatitis C; transgender women.

Figure 1.

Continuum of infection and treatment (cascade of care) for hepatitis C virus. Abbreviations: Ab+, anti-HCV (antibody) positive; HCV, hepatitis C virus; RNA+, HCV RNA detected in a blood specimen to confirm infection; SVR 12, sustained virologic response was found at 12 weeks posttreatment, indicated successful cure.

Figure 2.

Cascade of HCV care for people age ≤ 30 years who inject drugs in San Francisco, 2016–2020. Abbreviations: Cured, demonstrated HCV cure via sustained virologic response at 12 weeks posttreatment; diagnosed, active infection confirmed via RNA testing; HCV, hepatitis C virus; past/current infection, anti-HCV (antibody) positive; treated, self-reported initiating HCV treatment; YPWID, young people aged 30 years or younger who inject drugs.

Figure 3.

Cascade of HCV care for men who have sex with men and inject drugs in San Francisco, 2016–2020. Abbreviations: Cured, demonstrated HCV cure via sustained virologic response at 12 weeks posttreatment; diagnosed, active infection confirmed via RNA testing; HCV, hepatitis C virus; MSM, men who have sex with men; past/current infection, anti-HCV (antibody) positive; treated, self-reported initiating HCV treatment.

Figure 4.

Cascade of HCV care for low-income trans women in San Francisco, 2016–2020. Abbreviations: Cured, demonstrated HCV cure via sustained virologic response at 12 weeks posttreatment; diagnosed, active infection confirmed via RNA testing; HCV, hepatitis C virus; past/current infection, anti-HCV (antibody) positive; treated, self-reported initiating HCV treatment.