Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care

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Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care

Authors

Epstein, R. L.,Sabharwal, V.,Wachman, E. M.,Saia, K. A.,Vellozzi, C.,Hariri, S.,Linas, B. P.

Citation
2018
Journal of Pediatrics

203

34-40
Type
Retrospective cohort
Virus targets
Hepatitis C
Interventions
HCV testing and linkage to Care
Linkage to care
Screening and diagnosis
Testing
Setting
National
Target populations
Pregnant women
Country of development
United States of America
Target location
United States of America
DOI
10.1016/j.jpeds.2018.07.006
Testing strategy
Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test
Laboratory-based antibody test
Laboratory-based PCR/RNA (confirmatory) test
Countries of included studies
United States of America

Health outcomes

Linkage to care

Testing strategy

Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test

Abstract

Objectives: The US National Viral Hepatitis Action Plan calls for major efforts to expand hepatitis C virus (HCV) diagnosis and treatment; prenatal care settings are potential venues for expanding HCV testing. We aimed to characterize the HCV diagnostic cascade for women and infants and investigate factors associated with linkage and follow-up. Study design: We used electronic health records for a 10-year cohort of 879 women with opioid use disorder from an obstetric clinic serving women with substance use disorders. Result(s): Altogether, 744 women (85%) were screened for HCV; 510 (68%) were seropositive, of whom 369 (72%) had nucleic acid testing performed and of these 261 (71%) were viremic. Of 404 infants born to HCV-seropositive women, 273 (68%) were tested at least once for HCV, 180 (45%) completed the American Academy of Pediatrics-recommended perinatal HCV screening, and 5 (2.8%) were diagnosed with HCV infection and linked to care. More recent delivery date (2014-2015) was associated with maternal linkage to care (aOR, 2.5; 95% CI, 1.4-4.7). Maternal coinfection with HIV (aOR, 9.0; 95% CI, 1.1-72.8) and methadone maintenance therapy, compared with buprenorphine (aOR, 1.5; 95% CI, 0.9-2.5), were associated with higher rates of infant HCV testing. Conclusion(s): HCV prevalence among pregnant women with opioid use is high and infant HCV screening is imperfect. Programmatic changes to improve both mother and infant follow-up may help to bridge identified gaps in the cascade to cure. Copyright © 2018 Elsevier Inc.

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22 Jan 2021