San Francisco Study Shows Engagement in HCV Care Aids Elimination

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Many transwomen have access to hepatitis C virus testing and treatment, which suggests an opportunity for HCV control and elimination.

In San Francisco, many transwomen have access to hepatitis C virus (HCV) testing and treatment, which suggests an opportunity for HCV control and elimination, according to a study recently published in the Journal of Viral Hepatitis.

To reduce the burden of HCV disease and transmission, effective treatment is of high importance. The San Francisco Department of Public Health has declared achieving zero HCV infections a city priority. This goal is to be achieved by screening and treatment of populations at risk for HCV. Individuals who are stigmatized, marginalized, and those not adequately reached by screening and treatment programs are the populations most severely affected by HCV, which also includes people who inject drugs, people in correctional facilities, homeless individuals, men who have sex with men, and transwomen. Although transwomen have documented risks for HCV (multiple sex partners, sex work, drug use, etc), there are few data that document HCV prevalence in this population. Therefore, researchers conducted a cross-sectional survey to determine the prevalence of HCV and examined indicators of engagement in HCV care among transwomen in San Francisco.

In total, 315 transwomen were surveyed using a respondent-driven sampling method. The women included in the study provided informed consent, completed an interview-administered questionnaire, and provided blood samples for HCV and HIV antibody testing. HCV antibodies were detected using Oraquick® HCV Antibody Test. The interviewer-administered questionnaire included demographic characteristics, incarceration history, substance use by drug type and mode of use, and indicators of HCV care access and use. Descriptive statistics (ie, proportions) were used to summarize demographic and HCV risk-related variables, including HCV seroprevalence. The objective of this study was to provide baseline data on prevalence of infection and reach of services as San Francisco increases efforts to eliminate HCV.

Survey results showed that HCV antibody seropositivity in a community-recruited sample of transwomen was 9-fold higher than that of the general population in San Francisco. Overall, HCV seroprevalence was 23.8%. When compared with the general population, HCV seropositivity was significantly higher in transwomen who had ever injected drugs (48.2% vs 9.9%), smoked crack or methamphetamine (30.8% vs 12.5%), used intranasal drugs (28.4% vs 15.8%), or been incarcerated (27.9% vs 9.9%). However, HCV seroprevalence did not differ by HIV-positive vs HIV-negative serostatus (23.6% vs 24.0%, respectively).

In terms of indicators of engagement of HCV care, 79.4% of transwomen had previously been tested for HCV. Of the transwomen surveyed who were currently HCV seropositive, 80.7% reported being previously diagnosed with HCV. Of those previously diagnosed, 83.3% reported receiving viral load testing and 90.6% of those women reported a positive result. HCV treatment with a positive result was reported by 77.9% transwomen; 33.6% of those women were told they cleared the virus following treatment completion.

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The limitations of the study included a lack of resources to perform HCV viral load testing for current infection, sustained suppression, or reinfection. Further, it is unknown whether the sample surveyed is representative of all transwomen in San Francisco.

Researchers were encouraged with the results of engagement in HCV, noting that approximately 4 of 5 transwomen in this study were screened for HCV. Overall, the study authors concluded that, “HCV correlates and indicators of screening and treatment give direction to efforts to eliminate infection from this marginalized, disproportionately affected population.”


Wilson EC, Turner C, Lin J, McFarland W, Burk K, Raymond HF. Hepatitis C seroprevalence and engagement in related care and treatment among trans women [published online February 27, 2019] J Viral Hepat. doi: 10.1111/jvh.13089