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. 2018 Dec:203:34-40.e1.
doi: 10.1016/j.jpeds.2018.07.006. Epub 2018 Aug 28.

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

Rachel L Epstein  1 , Vishakha Sabharwal  2 , Elisha M Wachman  3 , Kelley A Saia  4 , Claudia Vellozzi  5 , Susan Hariri  5 , Benjamin P Linas  6
Affiliations

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

Rachel L Epstein et al. J Pediatr. 2018 Dec.

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.

Results: 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.

Conclusions: 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.

Keywords: linkage to care; pediatric hepatitis C; prenatal screening; vertical transmission.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1 Legend:
Figure 1 Legend:
a Assessed for HCV refers to history of HCV documented in EHR or completed HCV testing. Visualization of HCV Cascade to Cure for women and their infants. 1a: The percentage values at the top of each bar are conditional. 1b: Percentages for columns 2–3 are of the 404 infants ≥18 months old at study end born to HCV-seropositive mothers. Columns 4–5 percentage values are conditional. Abbreviations: HCV hepatitis C virus, RNA ribonucleic acid, EHR electronic health record.
Figure 2 Legend (Online Only):
Figure 2 Legend (Online Only):
Kaplan-Meier survival curve of time to maternal HCV Ab clearance for all 163 infants who ever had an initial positive HCV Ab followed by a negative Ab at a later time point. Imputed age in months at antibody clearance is calculated from the midpoint between age at last positive HCV Ab and first negative HCV Ab testing. Abbreviations: HCV hepatitis C virus, Ab antibody.
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References

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