HCV incidence and prevalence trends among people who use drugs in France 2004 to 2023

Hepatitis C virus (HCV) remains a key public health challenge, particularly among people who use and inject drugs (PWUD, PWID). While direct-acting antivirals (DAA) have revolutionized HCV treatment, meeting the WHO’s 2030 elimination target requires accurate estimation of incidence and prevalence to guide prevention and care. We analyze cross-sectional surveys conducted in France in 2004, 2013, and 2023, recruiting PWUD at harm reduction services and collecting behavioral and biological data. We estimate age-and time-dependent prevalence of HCV antibodies and HCV RNA using multivariate regression models while incidence was estimated from two-state transmission models. The demographic profile of PWUD has aged over time (mean age 35 years in 2004 vs. 44 in 2023) while injection prevalence remained stable (61.7% in 2023). Between 2013 and 2023, HCV burden declined substantially: HCV RNA prevalence fell from 19.4% (95% CI 16.3–23.0) to 9.5% (7.2–12.3) among all PWUD, and from 29.6% to 14.5% among PWID. Incidence among PWID decreased from 6.5 (4.1–8.0) to 2.4 (1.4–4.2) per 100 person-years. These reductions likely reflect the combined impact of DAA scale-up and harm reduction policies, marking substantial progress toward elimination targets. However, ongoing transmission highlights persistent barriers requiring targeted public health actions.