Factors associated with HCV coinfection and preferences for HCV screening services among people living with HIV/AIDS

BACKGROUND: The high prevalence of HCV coinfection among people living with HIV/AIDS has become a serious public health issue. This study aimed to understand the prevalence of HCV coinfection and its associated factors among people living with HIV/AIDS who were under follow-up care, as well as to explore their preferences for HCV screening methods. METHODS: The study selected people living with HIV/AIDS who were receiving follow-up treatment in a district of Southwest China, up to September 30, 2025. Demographic information and details about the HIV infection route were collected from the HIV/AIDS follow-up management database. Blood samples were collected from these patients to test for anti-HCV and HCV core antigens. For those with positive HCV antibodies but negative core antigens, HCV RNA was quantitatively detected using high-precision methods. Multivariable logistic regression was used to analyze the factors influencing HCV coinfection among people living with HIV/AIDS. A discrete choice experiment was conducted to investigate the preferences of 219 people living with HIV/AIDS regarding four free HCV screening attributes: testing institutions, transportation subsidies, result collection time, and screening interval. RESULTS: A total of 1,014 people living with HIV/AIDS who were screened for anti-HCV and HCV core antigens were included in this study. Among them, 27 (2.66%) tested positive for HCV RNA or HCV core antigen. Multivariable logistic regression analysis revealed that the risk of HCV coinfection was 4.79 times higher in divorced or widowed individuals compared to married individuals with a spouse (95%CI: 1.76-13.01, P = 0.002). HIV/AIDS patients with a history of injecting drug use had a 41.70 times higher risk of HCV coinfection compared to those infected through heterosexual transmission (95%CI: 6.72-258.68, P < 0.001). The testing institution, transportation subsidies, and result collection time were key factors influencing participation in free HCV screening among people living with HIV/AIDS (all P < 0.05). Participants preferred HCV screening methods conducted at ART medication distribution sites (β = 1.685), with transportation subsidies of 50 yuan or less (β = 0.707), and same-day result collection (β = 0.269). The relative importance analysis of the attributes showed that the testing institution was the most important factor in choosing an HCV screening method (62.55%), followed by transportation subsidies (26.24%). CONCLUSION: The prevalence of HCV coinfection among people living with HIV/AIDS in a district of Southwest China is at a moderate to low level. Divorced or widowed individuals and those who inject drugs should be prioritized for HCV screening. Integrating HCV screening into ART medication dispensing sites, providing transportation subsidies, and improving the timeliness of result feedback may help increase the acceptance and accessibility of HCV screening among people living with HIV/AIDS. CLINICAL TRIAL NUMBER: Not applicable.