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J Pediatr. 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.

Author information

1
Department of Pediatrics, Section of Infectious Diseases, Boston Medical Center, Boston, MA; Department of Internal Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA. Electronic address: rachel.epstein@bmc.org.
2
Department of Pediatrics, Section of Infectious Diseases, Boston Medical Center, Boston, MA.
3
Department of Pediatrics, Division of Neonatology, Boston Medical Center, Boston, MA.
4
Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA.
5
Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
6
Department of Internal Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA.

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

PMID:
30170857
PMCID:
PMC6252153
[Available on 2019-12-01]
DOI:
10.1016/j.jpeds.2018.07.006
[Indexed for MEDLINE]

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