Linkage to Care Leads to More Hepatitis C Treatment for Pregnant Women

Rachel L. Epstein, MD, MA

A more expansive care program for hepatitis C virus (HCV) treatment has led to more and more pregnant women beginning care.

A team, led by Rachel L. Epstein, MD, MA, Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, examined rates of HCV treatment initiation both prior to and during the expanded linkage to care treatment program.

HCV rates in the US continue to rise in young adults, particularly among pregnant women.

However, there are very few studies describing the linkage to care and treatment in pregnant or postpartum women with HCV infections.

Linkage to Care

The researchers used electronic health record data to estimate HCV treatment rates for postpartum women between January 2014 and September 2016 prior to the implementation of a maternal-infant HCV linkage program in combination with a multidisciplinary clinic to collocate mother and infant care and between October 2016 and March 2018.

The researchers used Poisson regression models to compare HCV treatment initiation rates, while adjusting for demographics, substance use, and treatment.

Throughout the duration of the study, 343 women who were HCV seropositive delivered and were included in the final analysis. Of this group, 95% of the patients completed HCV nucleic acid testing, while 255 had chronic HCV infections. The mean age of the patients was 30 years old and 96% were publicly insured.

In addition, 94% of the patients had documented substance use.

An Increase in HCV Treatment Initiation

Overall, HCV treatment initiation increased from 17.1% (n = 28) of chronic HCV women in the preintervention group to 24.2% (n = 16) with the linkage-only intervention regimen and 52% (n = 13) of patients in the linkage intervention and collocated care group.

After conducting an adjusted analyses, the researchers found women delivering during the intervention period were 2.40 times more likely to initiate HCV treatment (95% CI, 1.10-5.25; linkage only) and 3.36 times (95% CI, 1.57-7.17; linkage and colocated care) the rate of women delivering preintervention.

Individuals on buprenorphine also had higher HCV treatment initiation rates of those on methadone (rate ratio, 2.10; 95% CI, 1.05-4.21).

“HCV linkage to care and treatment rates improved in the setting of mother–infant linkage and colocated care interventions,” the authors wrote. “Perinatal care may represent a critical venue to identify, link, and treat women for HCV infection to improve their own health and prevent transmission to subsequent pregnancies.”

New Screening Recommendations

Recently, researchers found a pharmacist-led program for HCV treatment could enable patients to achieve a sustained virologic response while adhering to the desired treatment regimen.

The expansion of HCV screening to all adults in the US was officially recommended in March 2020. In part the recommendations increased the need for HCV Treatment programs and guidance for diverse populations.

The study, “Enhancing Linkage to Hepatitis C Virus Treatment Following Pregnancy in Women Identified During Perinatal Care,” was published online in Hepatology Communications.