Sex Disparities in Hepatitis C Treatment Initiation: Role of Universal Access to DAA in France ( ANRS FANTASIO 2)

BACKGROUND AND AIMS: Ensuring access to direct-acting antivirals (DAA) for all individuals concerned is a priority in hepatitis C elimination efforts. We analysed sex disparities in DAA initiation in France over a 9-year period spanning before and after August 2017, when the country implemented universal DAA access. METHODS: We used data from the French National Health Data System for two periods: 2014-2017 and 2017-2022. Socioeconomic and clinical characteristics of adults identified with chronic hepatitis C and residing in metropolitan France were described at each period entry date. DAA initiation incidence rates were then estimated and multivariable Cox proportional hazards models were used to identify potential sex disparities for each period. RESULTS: The study population comprised 97 817 and 98 020 individuals (61.3% and 62.0% men) before and after universal access to DAA, respectively. Comorbidity prevalence was significantly lower among women, except for psychiatric disorders. Compared with men, the incidence rate of DAA initiation was lower in women before universal access (24.5 [24.2-24.9] vs. 26.1 [25.8-26.3] per 100 person-years (PY), p < 0.001), and higher after (22.3 [21.9-22.6] vs. 18.5 [18.3-18.7] per 100 PY, p < 0.001). These differences were confirmed in multivariable models. CONCLUSIONS: In France, universal DAA access has reversed sex disparity in treatment initiation among people with chronic hepatitis C. This reversal likely reflects differences in disease progression profiles between men and women. To ensure truly equitable access to HCV care, current research should explore whether reversal or reduction of sex disparities is observed in other countries and subpopulations.