Universal HCV screening in pregnancy: Examining testing uptake and HCV care

PROJECT ABSTRACT: Hepatitis C virus (HCV) during pregnancy predominantly affects people who inject drugs. The rates of perinatal HCV and maternal to child transmission are rising in concert with the current injection drug use crisis. Testing for HCV in the perinatal period has been inadequate, as has testing of infants born to mothers infected with HCV. To improve testing rates, several professional societies released guidance recommend universal HCV testing with each pregnancy in spring of 2020. However, screening recommendations are not universally followed, and may not be applied equitably across populations. Additionally, we do not know whether an increase in testing ultimately leads to the desired downstream outcomes of linkage to care, treatment, and identification of infants at risk for perinatal transmission. In this proposal, we will use national Medicaid and commercial claims data to examine HCV testing and treatment among pregnant and postpartum women and their infants. Specifically, we will 1) determine whether the testing guideline change was associated with increased HCV testing rates among pregnant women compared to non-pregnant reproductive age women; 2) determine whether the guideline change was associated with increased postpartum HCV linkage to care and treatment as well as other aspects of maternal care, and 3) determine whether the guidelines were associated with increases in appropriate HCV testing and diagnoses for infants born to HCV-infected mothers in Medicaid. In each aim, we will examine variation in the implementation of HCV testing, identifying targets for further public health and policy intervention. Understanding the landscape of HCV testing for the perinatal population is critical for eliminating HCV and improving the lifetime health of people who use drugs.