Gender Differences in Hepatitis C Care Outcomes in the New York City Jail System, 2019-2023: A Retrospective Cohort Study.

BACKGROUND: Significant gaps in hepatitis C (HCV) care outcomes exist between women and men experiencing incarceration, yet limited data examining these differences exist in the literature. Our objective was to examine HCV care outcomes among women and men in a large urban jail. METHODS: A retrospective cohort analysis was completed of all persons incarcerated in the New York City (NYC) jail system who completed a medical intake between 1 October 2019 and 31 December 2023. Logistic regression models were used to calculate odds ratios for women versus men at each HCV care cascade step, including on-site HCV treatment initiation. Jail length of stay, history of mental health needs, homelessness, history of substance use disorders, history of HIV, and number of prior incarcerations in the last year were incorporated into the larger model. RESULTS: Of 71 100 individuals, 7.1% were women. Women had higher rates than men of HIV (3.7% vs 2.8%), mental health needs (55.1% vs 32.0%), select substance use disorders (58.5% vs 45.8%), homelessness (23.5% vs 19.5%) (P < .0001), and shorter jail lengths of stay (19 days vs 30 days, P < .0001). Of those with active HCV seen by an HCV clinician, women had about half the odds of on-site treatment initiation of men (multivariate adjusted odds ratios [AOR] = 0.561, 95% CI = .335-.925). CONCLUSIONS: Women were less likely to initiate jail-based HCV treatment compared to men despite similar infection rates and greater clinical engagement. Gender-focused strategies for HCV care in carceral settings are critical for achieving equitable HCV elimination.