Risk-Based Prenatal Hepatitis C Testing Practices and Results, Alaska 2013-2016

Nolen, Leisha D.; Gustin, Courtney; Seeman, Sara; Murphy, Neil; Truitt, Sarah T.; Schillie, Sarah; Bruce, Michael G.; Bruden, Dana; Tiesinga, James J.; McMahon, Brian J.

doi:10.1155/2019/8654741

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…Our study is the first to assess cost-effectiveness of HCV rescreening among pregnant women, supporting studies showing that HCV screening in pregnant women is cost-effective [3,4]. While our sensitivity analysis indicates that risk-based rescreening is more cost-effective than universal rescreening, it is much less effective (50% fewer QALYs gained) as a large proportion (34%-64%) [12,13] of highrisk women are not screened during pregnancy, leading to many missed diagnoses.…”

Section: Discussionsupporting

confidence: 59%

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Cost-effectiveness of Antenatal Rescreening Among Pregnant Women for Hepatitis C in the United States

Chaillon

Wynn

Kushner

et al. 2020

Clinical Infectious Diseases

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Section: Discussionsupporting

confidence: 59%

“…In the treatment restriction scenarios, individuals were eligible for treatment upon progression if remaining linked to care. We additionally assessed cost-effectiveness of risk-based rescreening during pregnancy, assuming 34%-64% of women with IDU will not be screened with this strategy [12,13].…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Cost-effectiveness of Antenatal Rescreening Among Pregnant Women for Hepatitis C in the United States

Chaillon

Wynn

Kushner

et al. 2020

Clinical Infectious Diseases

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“…This was a known limitation of the study as it has been well defined previously that risk-based screening underestimates the prevalence of HCV. 24,38 Also, our small sample of HCV seropositive pregnant women, and low linkage to HCV care rates limited power in detecting other predictors of followup and treatment failure beyond the perceived dependence on short-lived Medicaid insurance to access care. In addition, our follow-up was limited to our medical system, so women who sought care for HCV outside of our system were missed.…”

Section: Discussionmentioning

confidence: 99%

Pragmatic Experience with Risk-based versus Universal Hepatitis C Screening in Pregnancy: Detection of Infection and Postpartum Linkage to Care

et al. 2021

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Objective Despite the Centers for Disease Control and Prevention (CDC) and U.S. Preventive Services Task Force (USPSTF) recommending universal hepatitis C virus (HCV) screening in pregnancy Society for Maternal-Fetal Medicine (SMFM) and American College of Obstetricians and Gynecologists (ACOG) continue to endorse risk-based screening for HCV in pregnancy. We hypothesized that universal screening is associated with increased HCV diagnosis and postpartum linkage to HCV care compared with risk-based screening. Study Design This retrospective cohort study included pregnant women screened for HCV at a single tertiary-care center. We defined two cohorts: women managed with risk-based (January 2014–October 2016) or universal HCV screening (November 2016–December 2018). Screening was performed with ELISA antibody testing and viremia confirmed with HCV ribonucleic acid (RNA) polymerase chain reaction (PCR). Primary outcomes were the rate of HCV screen positivity and postpartum linkage to care. Results From 2014 to 2018, 16,489 women delivered at our institution, of whom 166 screened positive for HCV. A total of 7,039 pregnant women were screened for HCV: 266 with risk-based and 6,773 with universal screening; 29% (76/266) were positive HCV antibody screening (HCVAb + ) in the risk-based cohort and 1.3% (90/6,773) in the universal cohort. HCVAb+ women in the risk-based cohort were more likely to have a positive drug screen. Only 69% (62/90) of HCVAb+ women in the universal cohort met the criteria for risk-based testing. Of the remaining 28 women, 6 (21%) had active viremia (HCV RNA+). Of the 166 HCVAb+ women, 64% (103/166) were HCV RNA+—51 of 266 (19%) in the risk-based and 52 of 6,773 (0.8%) in the universal cohort. Of HCVAb+ women, 75% (125/166) were referred postpartum for HCV evaluation and 27% (34/125) were linked to care. Only 9% (10/103) of women with viremia initiated treatment within 1 year of delivery. Conclusion Universal HCV screening in pregnancy identified an additional 31% of HCVAb+ women compared with risk-based screening. Given low rates of HCV follow-up and treatment regardless of screening modality, further studies are needed to address barriers to postpartum linkage to care. Key Points

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“…Studies describing patients with documented risk factors who are not screened are evidence of this. 41,42 Adding more factors to consider while screening would most likely worsen this problem, as screening would become even more time intensive. While only two studies addressed this, 41,42 it is concerning that such apparent failures of risk-based screening have already been identified.…”

Section: Discussionmentioning

confidence: 99%

“…41 The possibility that risk-based screening may fail to identify women with known risk factors was also demonstrated in a 2019 study by Nolen et al which found 34% of women with documented drug use were not screened for HCV during their pregnancy. 42 The second type of comparative study found was a direct comparison between universal and risk-based screening. Many of these studies, in both the United States and abroad, had identified subsets of women who tested positive for HCV without any known risk factors.…”

Section: Risk-based Versus Universal Screeningmentioning

confidence: 99%

Hepatitis C Virus in Pregnancy: A Systematic Review of the Literature

et al. 2020

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Objective The aim of this study was to systematically review the literature to summarize recent demographic characteristics of hepatitis C virus (HCV) infection during pregnancy and the efficacy of risk-based versus universal screening. Study Design PubMed, EMBASE, and Cochrane Library were searched to identify relevant studies. Studies that recognized hepatitis C as a primary or secondary outcome, with pregnant women as the population and written in English, were included. Studies were excluded if they were abstracts only, written in foreign language, or published prior to 1992. Two researchers independently screened all the studies by titles, abstracts, and full text. Conflicts were settled by a third researcher. Results A total of 698 studies were identified with 78 fitting inclusion criteria. In total, 69 epidemiologic and 9 comparison studies were found. Identified risk factors for HCV infection include intravenous or illicit drug use, sexually transmitted coinfection, high-risk behaviors in the partners, high parity, and history of miscarriages or abortions. Demographic characteristics associated with HCV include non-Hispanic white race, American Indian or Alaskan Native ethnicity, and increasing age. Providers may fail to adequately screen for each risk factor, and up to two-thirds of women with a known risk factor are not screened under current guidelines. Finally, up to 27% of HCV+ women have no identifiable risk factors for infection. Conclusion There is evidence that risk-based screening fails to identify a large proportion of HCV positive women in pregnancy and that pregnant women with HCV risk factors and consistent with current screening guidelines fail to be tested. We urge for the adoption of universal screening to identify these women and offer treatment.

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Risk-Based Prenatal Hepatitis C Testing Practices and Results, Alaska 2013-2016

Cited by 10 publications

References 14 publications

Cost-effectiveness of Antenatal Rescreening Among Pregnant Women for Hepatitis C in the United States

Cost-effectiveness of Antenatal Rescreening Among Pregnant Women for Hepatitis C in the United States

Pragmatic Experience with Risk-based versus Universal Hepatitis C Screening in Pregnancy: Detection of Infection and Postpartum Linkage to Care

Hepatitis C Virus in Pregnancy: A Systematic Review of the Literature

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