Research Article| Volume 64, ISSUE 5, P695-703, May 2023

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Hepatitis C Virus Testing and Care Cascade Among Transgender and Gender Diverse Individuals

  • Hill L. Wolfe
    Address correspondence to: Hill L. Wolfe, PhD, MPA, Department of Health Law, Policy and Management, School of Public Health, Boston University, 715 Albany Street, Boston MA 02118.
    Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, Massachussetts
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  • Jaclyn M.W. Hughto
    Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, Rhode Island

    Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island

    Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island

    The Fenway Institute, Fenway Health, Boston, Massachussetts
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  • Meg Quint
    Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachussetts
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  • Leila Hashemi
    Division of Primary Care, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California

    David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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  • Landon D. Hughes
    Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan

    Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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Published:February 08, 2023DOI:


      Hepatitis C virus (HCV) prevalence among transgender and gender-diverse individuals ranges from 1.8% to 15.7% versus 1% in the general population. Previous HCV studies inclusive of transgender and gender-diverse individuals primarily rely on convenience-based sampling methods or are geographically restricted. The purpose of this study is to compare the prevalence of HCV diagnoses, testing, and care engagement between transgender and gender-diverse and cisgender individuals.


      Using Optum's de-identified Clinformatics® Data Mart Database, in 2022, the unadjusted prevalence of HCV testing among all adults and people who inject drugs from January 2001 to December 2019 was measured. Multivariable logistic regression was used to compare the adjusted odds of HCV diagnoses and care engagement by gender subgroup.


      The overall unadjusted frequency of HCV diagnoses among transgender and gender-diverse individuals was approximately 3 times that of cisgender individuals (1.06% vs 0.38%, p<0.001), including among people who inject drugs (6.36% vs 2.36%, p=0.007). Compared with cisgender women, transfeminine/nonbinary individuals had over 5 times the adjusted odds of a HCV diagnosis and approximately 3.5 times the odds of being tested for HCV. In addition, compared with cisgender women, transfeminine/nonbinary individuals had significantly increased odds of having a HCV‒related procedure (e.g., abdominal ultrasounds, liver biopsies, Fibroscans). Cisgender men had significantly increased odds of receiving HCV medication compared with cisgender women.


      Although testing was higher among transgender and gender-diverse individuals, the higher overall frequency of HCV diagnoses among transgender and gender-diverse than among cisgender individuals signals persistent health disparities. Interventions are warranted to prevent HCV and increase ongoing testing and treatment uptake among transgender and gender-diverse populations.
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