Awareness of hepatitis C knowledge among four high-risk populations in Xiamen, China: a cross-sectional study

Abstract Introduction Hepatitis C virus (HCV) infection remains a severe global public health challenge. Sufficient HCV knowledge among high-risk populations is essential to achieve the WHO 2030 goal of eliminating viral hepatitis. Comparative evidence on HCV knowledge awareness and its demographic determinants across men who have sex with men (MSM), drug users (DUS), female sex workers (FSW), and invasive procedure patients is scarce in Fujian Province. This study aimed to investigate the status of HCV knowledge awareness and explore its associated factors among the four high-risk populations in Xiamen, China. Methods A hospital- and community-based cross-sectional study was performed among 1621 valid participants. A standardized questionnaire developed by the Chinese Center for Disease Control and Prevention was adopted to collect sociodemographic information and HCV knowledge. Participants scoring ≥ 6 points in the 8 knowledge-related questions were defined as having adequate awareness level. The Chi‑square test and multivariable logistic regression analysis were used to compare intergroup differences and identify factors associated with adequate HCV knowledge. Results The overall HCV knowledge awareness rate was 76.5%, with significant differences across groups: MSM 91.0%, FSW 87.7%, DUS 75.3%, and invasive procedure patients only 51.9% ( χ 2 = 295.5, P < 0.001). Obvious knowledge gaps were identified in HCV curability among MSM and DUS, infection risk of novel psychoactive substance use among DUS, and misconceptions about occult infection and transmission routes among invasive procedure patients. Multivariable logistic regression revealed that college education or above was positively associated with adequate HCV knowledge in MSM (OR = 13.729, 95% CI : 4.030-46.767, P <0.001), DUS (OR = 16.201, 95% CI : 8.874–29.578, P <0.001), and invasive procedure patients (OR = 1.741, 95% CI : 1.074–2.822, P = 0.024). For FSW, aged ≥ 40 years (OR = 2.205, 95% CI : 1.091–4.457, P = 0.028) and Fujian household registration (OR = 2.696, 95% CI : 1.330–5.467, P = 0.006) were independent protective factors for better HCV knowledge. Conclusions Substantial disparities in HCV knowledge awareness exist among the four high-risk populations in Xiamen, with invasive procedure patients and DUS being the most disadvantaged groups. Education level, age and household registration were significantly associated with HCV knowledge awareness. Healthcare system-based interventions are crucial for invasive procedure patients, including preoperative HCV counseling, electronic medical record screening prompts, and clinical staff training. Tailored and differentiated health education interventions targeting elderly, migrant and low-education populations are urgently needed to fill knowledge gaps, block HCV transmission, and facilitate the achievement of national and regional hepatitis C elimination targets by 2030.