P-2190. Gender Differences in Hepatitis C Treatment in the New York City Jail System, 2019-2023

Abstract Background Little is known about Hepatitis C (HCV) care outcomes among women experiencing incarceration. Women make up only 7% of the New York City (NYC) jail population, but represent 18% of individuals diagnosed with active HCV. This study examines progress through the HCV care cascade among women and men in the NYC jail system and describes potential gender-related factors in cascade outcomes. Methods Persons admitted to the NYC jail system and who completed a medical intake between October 2019 and December 2023 were included in this retrospective cohort analysis. We constructed a care cascade describing rates of universal opt-out HCV screening, confirmatory testing, diagnosis, linkage to jail-based clinical HCV care, and jail-based HCV treatment among the jail population stratified by documented gender. Demographic characteristics and medical history were also examined and stratified by documented gender. Results 71,130 persons were included in our analysis, of whom 5,085 (7.1%) were women and 66,045 (92.9%) were men. Compared to men, women were screened at higher rates (88.7% vs. 28.1%; p< 0.001), underwent confirmatory testing at lower rates (9.6% vs 11.2%; p=0.002), and had similar rates of active HCV (51.2% vs 47.8%; p=0.22). Women with active HCV were seen by an HCV clinician at similar rates as men (55.4% vs. 59.6%; p=0.32) but initiated HCV treatment at nearly half the rate of men (15.3% vs. 30.3%; p< 0.001). Additionally, women in the NYC jails had significantly higher rates of homelessness (23.5% vs. 19.5%), HIV (3.7% vs. 2.7%), mental health needs (53.7% vs. 30.8%), and history of select substance use disorders (58.6% vs. 45.8%) when compared to men (p< 0.001). Conclusion Large HCV treatment gaps exist between women and men experiencing incarceration. Disproportionally higher rates of comorbid medical, mental health, and substance use disorders and more re-entry support needs likely contribute to treatment disparities. Gender-specific strategies centered on the needs of women with justice involvement are needed to enhance the equitable uptake of jail-based HCV treatment. Enhancing treatment access for all persons with justice involvement is critical for HCV elimination efforts. Disclosures All Authors: No reported disclosures