Hepatitis C Screening in an Underserved U.S. Cohort of Reproductive Age Women

Abstract

The opioid epidemic has recently increased the rates of hepatitis C virus (HCV) infection among young women. We therefore aimed to characterize the cascade of HCV care in a cohort of underserved women of reproductive age. Medical records of 19,121 women between the ages of 15 and 44 years, receiving primary care in the San Francisco safety‐net health care system, were reviewed. Cohort characteristics were as follows: median age 33 years (interquartile range 26‐38), 18% white (12% black, 46% Latina, 22% Asian, 2% other race), 1.3% hepatitis B surface antigen (HBsAg)‐positive, and 0.9% human immunodeficiency virus (HIV) co‐infection. HCV antibody (HCVAb) testing occurred in 38.7% (n = 7,406), of whom 2.8% (n = 206) were HCVAb‐positive and 2.4% (n = 177) had a detectable HCV viral load. Of the 5% (n = 1,017) with a history of pregnancy, 61% (n = 615) had HCVAb testing (2.6% were positive). On multivariable analysis, HBsAg testing (odds ratio [OR] 8.25 [95% confidence interval (CI)] 6.80‐10.01]; P < 0.001), HIV infection (OR 5.98 [95% CI 1.86‐19.20]; P = 0.003), and log alanine aminotransferase (ALT) (OR 1.30 [95% CI 1.16‐1.45]; P < 0.001) were associated with HCV screening. Compared with whites, women of Latina (OR 0.45 [95% CI 0.37‐0.55]; P < 0.001) and Asian (OR 0.74 [95% CI 0.58‐0.94]; P = 0.01) race were less likely to receive HCV screening. Age (OR 1.80 per decade [95% CI 1.26‐2.57]; P = 0.001), white race (versus non‐white; OR 10.48 [95% CI 7.22‐15.21]; P < 0.001), HIV infection (OR 3.25 [95% CI 1.40‐7.55]; P = 0.006), and log ALT (OR 1.93 [95% CI 1.49‐2.49]; P < 0.001) were associated with HCVAb positivity. Conclusion: Most (>60%) underserved women of reproductive age were not tested for HCV. Moreover, women of Latina and Asian race were less likely to receive HCV screening. Given the known high HCV risk in the underserved population, targeted interventions, especially for racial minority women of reproductive age, are needed to enhance HCV screening in those at risk.

Racial disparity in age and genotype defines urban hepatitis C patient profiles in the recent direct-acting antiviral era

“…1-4 While the number of treated patients has increased, the number of untreated, infected patients continues to be significant. [5][6][7][8][9][10][11][12][13] A study of predominantly African American (AA) patients in our university medical practice, during the interferon era (2002)(2003) and prior to the introduction of DAAs (2012-2013), confirmed that the AA population was within the age cohort for our patients through 2013. 5 While this aging cohort has traditionally represented the bulk of patients with HCV, the possibility that younger patients will be identified in recent populations is an important area of investigation.…”

“…The opioid epidemic appears to be an important contributor for the increase in younger populations being infected with HCV. 7 This has been associated with HCV infections and may be contributing to an increasing challenge for the eventual eradication of HCV. Support of this observation is found in multiple reports of an increase in HCV in younger individuals between 2006 and 2019, although many of these studies had significantly fewer AA as compared to non-AA patients.…”

Enhancing Linkage to Hepatitis C Virus Treatment Following Pregnancy in Women Identified During Perinatal Care

“…( 16 , 17 ) Linking new mothers to care could improve not only their own health through seeking cure but also follow‐up for their HCV‐exposed infant and prevent vertical transmission in future pregnancies. Few studies describe HCV referral and treatment practices in women diagnosed with HCV during pregnancy, ( 5 , 17 , 18 , 19 , 20 , 21 ) and only one describes HCV treatment in the DAA era, with improved treatment rates for a limited number of postpartum women compared to the general population. ( 20 )…”

“…Few studies describe HCV referral and treatment practices in women diagnosed with HCV during pregnancy, ( 5 , 17 , 18 , 19 , 20 , 21 ) and only one describes HCV treatment in the DAA era, with improved treatment rates for a limited number of postpartum women compared to the general population. ( 20 )…”

Association of Referral Source and Substance Use with Hepatitis C Virus Outcomes at a Southern Academic Medical Center

“…12 These medication advances suggest that the primary barriers to HCV elimination are preventing new transmissions, diagnosing those who are infected, and improving access to and completion of curative therapy, all of which are factors that can be influenced by psychosocial and structural factors. 13,14 With respect to these barriers, HCV testing is still below recommended rates in certain healthcare settings, 15 which is especially notable as the US Preventive Services Task Force expanded its screening recommendation to include all adults. 16 Prior studies examining the HCV cascade of care identified younger age, mental illness, and active substance use as risk factors for being lost to follow-up after a diagnosis is made.…”