Hepatitis C care continuum and associated barriers among people who inject drugs in Chennai, India

•PWID had poor linkage to HCV care and uptake of HCV treatment.•PWID had inadequate knowledge of HCV treatment.•HCV treatment willingness improved with decreasing duration of therapy.•PWID preferred daily visits to a clinic for HCV treatment.•Barriers to HCV care differed by HIV/HCV co-infection status. Little is known regarding barriers to hepatitis C virus (HCV) treatment among people who inject drugs (PWID) in low-resource settings, particularly in the era of direct-acting antiviral therapies. Between March, 2015–August, 2016, a cross-sectional survey was administered to community-based PWID in Chennai, India to examine the HCV care continuum and associated barriers. Adjusted prevalence ratios (APR) were estimated by multivariable Poisson regression with robust variance. All participants were male (n = 541); 152 participants had HCV mono-infection and 61 participants had HIV/HCV co-infection. Only one HCV mono-infected and one HIV/HCV co-infected participant was linked to HCV care. Overall, there was moderate knowledge of HCV disease but poor knowledge of HCV treatment. Higher total knowledge scores were negatively associated with HIV/HCV co-infection (vs. HCV mono-infection), though this was not statistically significant in adjusted analysis (APR = 0.71 [95%CI = 0.47–1.06]). Participants ≥45 years (APR = 0.73 [95%CI = 0.58–0.92]) and participants with HIV/HCV co-infection (APR = 0.64 [95%CI = 0.47–0.87]) were less willing to take weekly interferon injections for 12 weeks. Willingness to undergo HCV treatment improved with decreasing duration of therapy, higher perceived efficacy, and use of pills vs. interferon, though willingness to use interferon improved with decreasing duration of therapy. Most participants preferred daily visits to a clinic for HCV treatment versus receiving a month’s supply. Participants ≥45 years (vs.