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Alcohol use disorder (AUD), common within this population, has been identified as a barrier to HCV treatment uptake in the general population. We investigated whether the arrival of new and well\u2010tolerated HCV treatments (direct\u2010acting antivirals: DAA) has improved HCV treatment uptake in French PWID compared with former treatments (pegylated interferon\u2010based treatments: Peg\u2010IFN).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Using discrete\u2010time Cox proportional hazards models based on exhaustive care delivery data, we tested for associations between AUD (defined by AUD\u2010related long\u2010term illness status, diagnosis coding during hospitalization and\/or AUD pharmacological treatment) and first HCV treatment delivery, after adjusting for gender, age, complementary universal health cover, liver disease severity and type of opioid agonist therapy (OAT) received. Separate analyses were performed for 2012\u201313 (Peg\u2010IFN era) and 2014\u201316 (DAA era).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>France.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>All French people chronically HCV\u2010infected who received OAT at least once during 2012\u201316 and were covered by the national health insurance (<jats:italic>n<\/jats:italic>\u00a0=\u00a024\u2009831).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Incidence rate of HCV treatment uptake, hazard ratios associated with AUD and other covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Incidence rate (IR) of HCV treatment uptake per 100 person\u2010years was 6.56, confidence interval (CI)\u00a0=\u00a06.30\u20136.84; and IR\u00a0=\u00a05.70, 95% CI\u00a0=\u00a05.51\u20135.89 for Peg\u2010IFN\u2010based treatment (2012\u201313) and DAA (2014\u201316), respectively. After multiple adjustment, people with AUD not receiving related medication had 30 and 14% lower Peg\u2010IFN\u2010based treatment and DAA uptake, respectively, than those without AUD [hazard ratio (HR)\u00a0=\u00a00.70, 95% CI\u00a0=\u00a00.62\u20130.80 and HR\u00a0=\u00a00.86, 95% CI\u00a0=\u00a00.78\u20130.94]. No difference was observed between those treated for AUD and those without AUD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite the benefits of direct\u2010acting antiviral treatment, untreated alcohol use disorder appears to remain a major barrier to hepatitis C virus treatment access for people who inject drugs in France.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.14820","type":"journal-article","created":{"date-parts":[[2019,10,9]],"date-time":"2019-10-09T05:34:10Z","timestamp":1570599250000},"page":"573-582","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Untreated alcohol use disorder in people who inject drugs (PWID) in France: a major barrier to HCV treatment uptake (the ANRS\u2010FANTASIO 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