Hepatitis C Screening and Gender Disparities in Positivity Rates in Argentina: A Multicenter Study.

Abstract

Introduction: . Anti-HCV seropositivity is a public-health concern in Argentina, with potential disparities by gender. We estimated anti-HCV seropositivity in a multicenter public laboratory network, described gender-based differences, and examined the association with all-cause mortality.

Methods: Retrospective observational study with centralized chemiluminescent immunoassay testing at Hospital El Cruce, using samples from 64 public centers from January 1, 2013 to December 31, 2023. The analyses were performed at the patient level (the first test per person) and the positivity rate was calculated for each testing site. Vital status information was obtained from hospital records and RENAPER (with a cut-off date of December 2024). Mortality by anti-HCV serostatus was assessed using logistic regression with a prespecified 2:1 matching on age, gender, and testing site.

Results: Of the 74,503 adults tested, 1,101 (1.48%) were anti-HCV-positive. Of those tested, 83.0% were women (61,837/74,503) and 17.0% were men (12,666/74,503). Within gender seropositivity was 0.73% in women (451/61,837) and 5.05% in men (639/12,666). The per-test positivity rate was 0.5% in peripheral centers (451/90,194) and 5.1% in the hospital (922/18,082). Of the individuals who tested positive for anti-HCV, 25.0% (275/1,101) were deceased at the cut-off date. In a matched cohort of 2:1 by age, gender, and site, anti-HCV positivity was associated with a higher risk of death (adjusted OR 4.75; 95% CI 3.82 - 5.94; p < 0.001).

Conclusions: Men were tested much less frequently than women (17.0% versus 83.0% of those tested), yet they were far more likely to test positive for anti-HCV (5.05% versus 0.73% within gender), accounting for the majority of positive results (58%). Therefore, screening policies should prioritize increasing testing among men, especially in high-yield hospital settings, and ensure rapid linkage to care. The association between anti-HCV seropositivity and higher mortality reinforces the urgency of these actions.