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Subst Abus. 2016;37(1):88-95. doi: 10.1080/08897077.2015.1118720. Epub 2015 Nov 16.

Screening and evaluation of hepatitis C virus infection in pregnant women on opioid maintenance therapy: A retrospective cohort study.

Author information

1
a Department of Obstetrics , Gynecology and Reproductive Sciences , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
2
b Magee-Womens Research Institute , Pittsburgh , Pennsylvania , USA.
3
c Center for Health Equity Research and Promotion , Veteran's Administration (VA) Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.
4
d Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
5
e Department of General Internal Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.

Abstract

BACKGROUND:

The purpose of this study was to describe the delivery of prenatal care services to women with opioid use disorder (OUD) on opioid maintenance therapy at high risk for hepatitis C virus (HCV) infection.

METHODS:

We conducted a retrospective cohort evaluation of 791 pregnant women with OUD from 2009 to 2012. HCV screening was defined as documentation of (a) an anti-HCV antibody test or (b) a provider discussion regarding a known HCV diagnosis during pregnancy. Multivariate logistic regression was used to identify predictors of HCV screening during pregnancy.

RESULTS:

Among 791 pregnant women with OUD, 611 (77.2%) were screened for HCV infection and 369/611 (60.4%) were HCV positive. In multivariable analysis, patients who were married (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.29, 0.91), used buprenorphine (OR = 0.45; 95% CI = 0.28, 0.71), and were cared for by private practice providers (OR = 0.29; 95% CI = 0.19, 0.45) were significantly less likely to be screened. In contrast, patients who used benzodiazepines (OR = 1.72; 95% CI = 1.02, 2.92), intravenous (IV) opioids (OR = 6.15; 95% CI = 3.96, 9.56), had legal problems (OR = 2.23; 95% CI = 1.12, 4.45), had children not in their custody (OR = 1.81; 95% CI = 1.01, 3.24), and who had a partner with substance abuse history (OR = 2.38; 95% CI = 1.23, 4.59) were significantly more likely to be screened. Of 369 HCV-positive patients, a new diagnosis of HCV was made during pregnancy for 108 (29.3%) patients. Only 94 (25.5%) had HCV viral load testing, 61 (16.5%) had HCV genotype testing, and 38 (10.4%) received an immunization for hepatitis A. Although 285 (77.2%) patients were referred to hepatology, only 71 (24.9%) attended the consultation. Finally, only 6 (1.6%) patients received HCV treatment 1 year following delivery.

CONCLUSIONS:

Prenatal care approaches to HCV infection remain inconsistent, and the majority of patients diagnosed with HCV infection during pregnancy do not receive treatment after delivery.

KEYWORDS:

Hepatitis C virus; opioid dependence; pregnancy; prenatal care screening

PMID:
26569631
PMCID:
PMC4827149
DOI:
10.1080/08897077.2015.1118720
[Indexed for MEDLINE]
Free PMC Article

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