Universal Screening of Pregnant Women for Hepatitis C: The Time Is Now

Currently, risk-based hepatitis C virus (HCV) screening is recommended for women of childbearing age and pregnant women despite a high HCV prevalence. For many reasons outlined here, the time has come for universal screening for HCV for all pregnant women.

Download Full-text

Hepatitis C Virus in Women of Childbearing Age, Pregnant Women, and Children

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2018.05.029 ◽

2018 ◽

Vol 55 (5) ◽

pp. 633-641 ◽

Cited By ~ 12

Author(s):

Sarah F. Schillie ◽

Lauren Canary ◽

Alaya Koneru ◽

Noele P. Nelson ◽

Wade Tanico ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Pregnant Women ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Women And Children

Download Full-text

TRANSFUSION COMPLICATIONS: Declining hepatitis C virus (HCV) prevalence in pregnant women: impact of anti-HCV screening of donated blood

Transfusion ◽

10.1111/j.1537-2995.2009.02487.x ◽

2009 ◽

Vol 50 (3) ◽

pp. 693-700 ◽

Cited By ~ 6

Author(s):

Hitoshi Ohto ◽

Tsutomu Ishii ◽

Junichi Kitazawa ◽

Seiji Sugiyama ◽

Niro Ujiie ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Pregnant Women ◽

Hcv Prevalence ◽

Hcv Screening ◽

Donated Blood ◽

Transfusion Complications

Download Full-text

Information for CME Credit—Hepatitis C Virus in Women of Childbearing Age, Pregnant Women and Children

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2018.09.002 ◽

2018 ◽

Vol 55 (5) ◽

pp. A4

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Pregnant Women ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Women And Children

Download Full-text

Increased Hepatitis C Virus (HCV) Detection in Women of Childbearing Age and Potential Risk for Vertical Transmission — United States and Kentucky, 2011–2014

MMWR Morbidity and Mortality Weekly Report ◽

10.15585/mmwr.mm6528a2 ◽

2016 ◽

Vol 65 (28) ◽

pp. 705-710 ◽

Cited By ~ 68

Author(s):

Alaya Koneru ◽

Noele Nelson ◽

Susan Hariri ◽

Lauren Canary ◽

Kathy J. Sanders ◽

...

Keyword(s):

United States ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Vertical Transmission ◽

Potential Risk ◽

Women Of Childbearing Age ◽

Childbearing Age

Download Full-text

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

American Journal of Perinatology ◽

10.1055/s-0041-1728827 ◽

2021 ◽

Author(s):

Elisa T. Bushman ◽

Lakshmi Subramani ◽

Aalok Sanjanwala ◽

Jodie Dionne-Odom ◽

Ricardo Franco ◽

...

Keyword(s):

Hepatitis C ◽

Pregnant Women ◽

Universal Screening ◽

Task Force ◽

Care Center ◽

Tertiary Care ◽

Linkage To Care ◽

Hcv Rna ◽

Hcv Screening ◽

In Pregnancy

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

Download Full-text

Hepatitis C Seroprevalence Among Consecutive Labor and Delivery Admissions in Two New York City Hospitals

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa514 ◽

2020 ◽

Vol 7 (11) ◽

Author(s):

Tatyana Kushner ◽

Claire Park ◽

Dana Masand ◽

Brian Wagner ◽

Marie Grace ◽

...

Keyword(s):

Risk Factors ◽

New York ◽

New York City ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Pregnant Women ◽

York City ◽

Private Insurance ◽

Labor And Delivery ◽

Childbearing Age

Abstract Background Rates of hepatitis C virus (HCV) among women of childbearing age have increased as a result of the opioid epidemic, especially in the nonurban white population. Recently updated US Preventative Services Task Force and Centers for Disease Control and Prevention guidance have recommended universal HCV screening during pregnancy, but obstetrics societies have not yet endorsed this recommendation. We evaluated the seroprevalence of HCV among pregnant women in an inner-city population, compared rates with other sexually transmitted infections (STIs) screened for during pregnancy, and evaluated factors associated with HCV positivity. Methods We performed a prospective seroprevalence study of consecutive labor and delivery admissions (both antepartum complications and delivery admissions) by testing serum samples for HCV antibody over 9 months at 2 major hospital settings in New York City. Results Fifty-six of 7373 (0.75%; 95% confidence interval [CI], 0.57–0.98) patients screened positive for HCV, with 28 of 4013 (0.70%; 95% CI, 0.46%–1.01%) and 28 of 3413 (0.82%; 95% CI, 0.55%–1.18%) at each hospital. Forty-one percent of HCV-positive patients had any reported HCV risk factors. Hepatitis C virus-positive patients were less likely to have private insurance and more likely to have a history of cannabis, cocaine, and injection drug use (P < .001). The HCV rates were higher among antepartum admissions compared with delivery admissions and higher than that of hepatitis B virus (0.65%; 95% CI, 0.48–0.86), human immunodeficiency virus (0.27%; 95% CI, 0.16–0.42), and syphilis (0.16%; 95% CI, 0.08–0.28). Conclusions We found a higher than expected HCV seroprevalence among pregnant women and higher than most other STIs routinely screened for in pregnancy. Most patients had no risk factors. These findings support universal screening for hepatitis C during pregnancy.

Download Full-text

Cost-effectiveness of hepatitis C virus screening, and subsequent monitoring or treatment among pregnant women in the Netherlands

The European Journal of Health Economics ◽

10.1007/s10198-020-01236-2 ◽

2020 ◽

Cited By ~ 1

Author(s):

Job F. H. Eijsink ◽

Mohamed N. M. T. Al Khayat ◽

Cornelis Boersma ◽

Peter G. J. ter Horst ◽

Jan C. Wilschut ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

The Netherlands ◽

Pregnant Women ◽

Risk Groups ◽

Subsequent Treatment ◽

Migrant Women ◽

Hcv Screening ◽

The Impact ◽

First Time

Abstract Background The prevalence of diagnosed chronic hepatitis C virus (HCV) infection among pregnant women in the Netherlands is 0.26%, yet many cases remain undiagnosed. HCV screening and treatment of pregnant HCV carriers could reduce the burden of disease and limit vertical transmission from mother to child. We assessed the impact of HCV screening and subsequent treatment with new direct-acting antivirals (DAAs) among pregnant women in the Netherlands. Methods An HCV natural history Markov transition state model was developed, to evaluate the public-health and economic impact of HCV screening and treatment. Besides all 179,000 pregnant women in the Netherlands (cohort 1), we modelled 3 further cohorts: all 79,000 first-time pregnant women (cohort 2), 33,000 pregnant migrant women (cohort 3) and 16,000 first-time pregnant migrant women (cohort 4). Each cohort was analyzed in various scenarios: i no intervention, i.e., the current practice, ii screen-and-treat, i.e., the most extensive approach involving treatment of all individuals found HCV-positive, and iii screen-and-treat/monitor, i.e., a strategy involving treatment of symptomatic (F1–F4) patients and follow-up of asymptomatic (F0) HCV carriers with subsequent treatment only at progression. Results For all cohorts, comparison between scenarios (ii) and (i) resulted in ICERs between €9,306 and €10,173 per QALY gained and 5 year budget impacts varying between €6,283,830 and €19,220,405. For all cohorts, comparison between scenarios (iii) and (i) resulted in ICERs between €1,739 and €2,749 per QALY gained and budget impacts varying between €1,468,670 and €5,607,556. For all cohorts, the ICERs (scenario iii versus ii) involved in delayed treatment of asymptomatic (F0) HCV carriers varied between €56,607 and €56,892, well above the willingness-to-pay (WTP) threshold of €20,000 per QALY gained and even above a threshold of €50,000 per QALY gained. Conclusion Universal screening for HCV among all pregnant women in the Netherlands is cost-effective. However, it would be reasonable to consider smaller risk groups in view of the budget impact of the intervention.

Download Full-text

Cost-effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in the United States

Clinical Infectious Diseases ◽

10.1093/cid/ciz063 ◽

2019 ◽

Vol 69 (11) ◽

pp. 1888-1895 ◽

Cited By ~ 19

Author(s):

Antoine Chaillon ◽

Elizabeth B Rand ◽

Nancy Reau ◽

Natasha K Martin

Keyword(s):

United States ◽

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

Pregnant Women ◽

Cost Effective ◽

The United States ◽

Lifetime Horizon ◽

Hcv Screening ◽

The Cost

Abstract Background Hepatitis C virus’ (HCV) chronic prevalence among pregnant women in the United States doubled nationally from 2009–2014 (~0.7%), yet many cases remain undiagnosed. Screening pregnant women is not recommended by the Society of Maternal-Fetal Medicine or the Centers for Disease Control and Prevention, despite new American Association For the Study of Liver Diseases (AASLD)/Infectious Diseases Society of America (IDSA) guidelines recommending screening for this group. We assessed the cost-effectiveness of HCV screening for pregnant women in the United States. Methods An HCV natural history Markov model was used to evaluate the cost-effectiveness of universal HCV screening of pregnant women, followed by treatment after pregnancy, compared to background risk-based screening from a health-care payer perspective. We assumed a HCV chronic prevalence of 0.73% among pregnant women, based on national data. We assumed no Medicaid reimbursement restrictions by fibrosis stage at baseline, but explored differing restrictions in sensitivity analyses. We assessed costs (in US dollars) and health outcomes (in quality-adjusted life-years [QALYs]) over a lifetime horizon, using new HCV drug costs of $25 000/treatment. We assessed mean incremental cost-effectiveness ratios (ICERs) under a willingness-to-pay threshold of $50 000/QALY gained. We additionally evaluated the potential population impact. Results Universal antenatal screening was cost-effective in all treatment eligibility scenarios (mean ICER <$3000/QALY gained). Screening remained cost-effective at a prevalence of 0.07%, which is the lowest estimated prevalence in the United States (in Hawaii). Screening the ~5.04 million pregnant women in 2018 could result in the detection and treatment of 33 000 women, based on current fibrosis restrictions. Conclusions Universal screening for HCV among pregnant women in the United States is cost-effective and should be recommended nationally.

Download Full-text