Gaps in the hepatitis C continuum of care among sex workers in Vancouver, British Columbia: Implications for voluntary hepatitis C virus testing, treatment and care.
BACKGROUND
Hepatitis C virus (HCV) eradication leads to reduced morbidity, mortality and transmission. Despite the disproportionate burden of HCV among sex workers, data regarding the HCV care continuum in this population remain negligible.


METHODS
Using baseline data from an ongoing cohort of women sex workers in Vancouver (An Evaluation of Sex Workers' Health Access, January 2010 to August 2013), the authors assessed HCV prevalence and engagement in the HCV care continuum within the past year. Multivariable logistic regression analyses were used to evaluate associations with recent (ie, in the past year) HCV testing.


RESULTS
Among 705 sex workers, 302 (42.8%) were HCV seropositive. Of these, 22.5% were previously unaware of their HCV status, 41.7% had accessed HCV-related care, 13.9% were offered treatment and only 1.0% received treatment. Among 552 HCV-seronegative sex workers, only one-half (52.9%) reported a recent HCV test. In multivariable analysis, women who self-identified as a sexual⁄gender minority (adjusted OR [aOR] 1.89 [95% CI 1.11 to 3.24]), resided in the inner city drug use epicentre (aOR 3.19 [95%CI 1.78 to 5.73]) and used injection (aOR 2.00 [95% CI 1.19 to 3.34]) or noninjection drugs (aOR 1.95 [95% CI 1.00 to 3.78]) had increased odds of undergoing a recent HCV test, while immigrant participants (aOR 0.24 [95% CI 0.12 to 0.48]) had decreased odds.


CONCLUSIONS
Despite a high burden of HCV among sex workers, large gaps in the HCV care continuum remain. Particularly concerning are the low access to HCV testing, with one-fifth of women living with HCV being previously unaware of their status, and the exceptionally low prevalence of HCV treatment. There is a critical need for further research to better understand and address barriers to engage in the HCV continuum for sex workers.
M Eugenia
ME
Socías
Kate
K
Shannon
Julio S
JS
Montaner
Silvia
S
Guillemi
Sabina
S
Dobrer
Paul
P
Nguyen
Shira
S
Goldenberg
Kathleen
K
Deering
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001727:Bisexuality / Q000706:statistics & numerical data; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D003144:Communication Barriers; D003266:Continuity of Patient Care; D019468:Disease Management; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D018452:Homosexuality, Female / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008913:Minority Groups / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D015995:Prevalence; D011330:Prisons; D012111:Residence Characteristics; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D063106:Transgender Persons / Q000706:statistics & numerical data
D000998:Antiviral Agents