Association Between Sex and Recent Pregnancy and Hepatitis C Virus Treatment in People With Opioid Use Disorder

To evaluate the association between sex and recent pregnancy and treatment of hepatitis C virus (HCV) infection in individuals entering opioid use disorder (OUD) treatment in the United States.

We used the Merative MarketScan Commercial and Multi-State Medicaid Databases (2015-2019) to conduct a retrospective cohort study of individuals with HCV infection entering OUD treatment. The outcome variable of interest was the prescription of direct-acting antivirals (DAAs) after the initiation of OUD treatment, and the exposure variables of interest were sex and recent pregnancy status. We used Cox regression models to perform univariate analyses to determine differences in HCV treatment rates based on sex and recent pregnancy status and ran multivariable analyses adjusted for covariates including age, year of enrollment, insurance type, race and ethnicity, psychiatric comorbidities, co-occurring substance use disorders (alcohol use disorder, cannabis use disorder, stimulant use disorder), hospitalizations for drug-related poisoning, OUD treatment type, and Charlson Comorbidity Index score.

Our analysis included 19,668 people with HCV infection initiating OUD treatment (90.8% with Medicaid insurance, 89.2% non-Hispanic White), of whom 8,864 (45.1%) were men, 7,567 (38.5%) were women without recent pregnancy, and 3,237 (16.5%) were women with recent pregnancy. Overall, 7,332 individuals (37.3%) were prescribed DAAs within 1 year of OUD treatment. Men were most likely to be prescribed DAAs within 1 year of OUD treatment (40.6%), followed by women without recent pregnancy (35.7%) and women with recent pregnancy (31.8%). In adjusted analyses, men and women without recent pregnancy had higher rates of HCV treatment compared with women with recent pregnancy (adjusted hazard ratio 1.18, 95% CI, 1.13-1.24; and 1.09, 95% CI, 1.04-1.13, respectively).

Among people with HCV infection entering OUD treatment in the United States, female sex and recent pregnancy are independent risk factors for reduced likelihood of direct-acting antiviral prescription, of which the latter may contribute to sex-based disparities in access to DAAs.