The Kirby Institute, UNSW Sydney, Sydney, Australia.
Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
Drug Alcohol Rev. 2024 Jul;43(5):1080-1092. doi: 10.1111/dar.13688. Epub 2023 May 30.
Females of childbearing age with hepatitis C virus (HCV) face increased marginalisation with intersecting, sex-specific barriers to direct acting antiviral (DAA) therapy. We assessed the factors associated with uptake of DAA therapy among females of childbearing age, including those with evidence of recent drug dependence.
HCV notifications in New South Wales, Australia (1995-2017) were linked to opioid agonist therapy (OAT), hospitalisations, incarcerations, perinatal, HIV notifications, deaths and prescription databases. Recent drug dependence was defined as hospitalisation due to injectable drugs or receipt of OAT occurring in the DAA era (2016-2018). Logistic regression was used to analyse factors associated with DAA uptake among females of childbearing age (18-44), including those with recent drug dependence.
Among 57,467 people with evidence of chronic HCV in the DAA era (2016-2018), 20,161 (35%) were female, including 33% (n = 6563/20,161) of childbearing age (18-44). Among all females of childbearing age (n = 6563) and those with evidence of recent drug dependence (n = 2278/6563, 35%), DAA uptake was lower among those who had given birth in the DAA era (vs. no birth record, all females of childbearing age; aOR: 0.74, 95% CI 0.61, 0.89; those with recent drug dependence; aOR 0.69, 95% CI 0.51, 0.93) and Aboriginal and Torres Strait Islander peoples (all females of childbearing age; aOR 0.81, 95% CI 0.71, 0.93; those with recent drug dependence aOR 0.75, 95% CI 0.62, 0.90).
Females of childbearing age should be considered a key population for DAA therapy. Enhancing antenatal and postnatal HCV care may be critical in the pursuit towards elimination.
患有丙型肝炎病毒 (HCV) 的育龄女性面临着越来越多的边缘化问题，因为她们在获得直接作用抗病毒 (DAA) 治疗方面存在交叉的、特定于性别的障碍。我们评估了与育龄女性（包括有近期药物依赖证据的女性）接受 DAA 治疗相关的因素。
在澳大利亚新南威尔士州（1995-2017 年），将 HCV 通知与阿片类药物替代疗法 (OAT)、住院、监禁、围产期、HIV 通知、死亡和处方数据库联系起来。近期药物依赖定义为在 DAA 时代（2016-2018 年）因注射药物或接受 OAT 而住院。使用逻辑回归分析了与育龄女性（18-44 岁）接受 DAA 治疗相关的因素，包括有近期药物依赖的女性。
在 DAA 时代（2016-2018 年）有慢性 HCV 证据的 57467 人中，有 20161 人（35%）为女性，其中 33%（n=6563/20161）为育龄女性（18-44 岁）。在所有育龄女性（n=6563）和有近期药物依赖证据的女性（n=6563 中有 2278 人，35%）中，在 DAA 时代分娩过的女性（与无分娩记录的女性相比），DAA 使用率较低所有育龄女性；aOR：0.74，95%CI 0.61，0.89；有近期药物依赖的女性；aOR 0.69，95%CI 0.51，0.93）和原住民和托雷斯海峡岛民（所有育龄女性；aOR 0.81，95%CI 0.71，0.93；有近期药物依赖的女性 aOR 0.75，95%CI 0.62，0.90）。
育龄女性应被视为 DAA 治疗的重点人群。加强围产期 HCV 护理对于实现消除目标可能至关重要。
