Direct-acting antiviral Hepatitis C treatment cascade and barriers to treatment initiation among US men and women with and without HIV.

Background People with HIV are disproportionately co-infected with hepatitis C virus (HCV) and experience accelerated liver-related mortality. Direct-acting antivirals (DAAs) yield high sustained virologic response (SVR) rates, but uptake is suboptimal. This study characterizes the DAA-era HCV treatment cascade and barriers among US men and women with or at risk for HIV. Methods We constructed HCV treatment cascades using data from The Women's Interagency HIV Study (women, six visits, 2015-2018, n=2,447) and Multicenter AIDS Cohort Study (men, one visit, 2015-2018, n=2,221). Cascades included treatment-eligible individuals (i.e., HCV RNA+ or reported DAAs). Surveys captured self-reported clinical (e.g., CD4), patient (e.g., missed visits), system (e.g., appointment access), and financial/insurance barriers. Results 323 women and 92 men were treatment-eligible. Most women/men had HIV (77%/70%); 69%/63% were Black. HIV+ women were more likely to attain cascade outcomes than HIV- women (39% vs. 23% initiated, 21% vs. 12% SVR); similar discrepancies were noted for men. Black men and substance users were treated less often. Women initiating treatment (vs. not) reported fewer patient (14%/33%) barriers. Among men not treated, clinical barriers were prevalent (53%). Conclusions HIV care may facilitate HCV treatment linkage and barrier navigation. HIV- individuals, Black men, and substance users may need additional support.