Graduate Assistant Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida Gainesville, United States
Background: Several recent guidelines have emphasized that timely prenatal screening for Hepatitis C virus (HCV) is crucial for early identification of active or reactivated hepatitis C infection in pregnant individuals. The Center for Disease Control (CDC) recommended universal HCV screening of all pregnancies in spring 2020. The impact of these guidelines on universal prenatal HCV screening and determinants for failure to screen are incompletely described.
Objectives: To evaluate secular trends and determinants of HCV screening during pregnancy.
Methods: We identified pregnancy episodes within the Merative MarketScan Commercial Claims database, which provides a national sample of privately insured individuals in the US. We included individuals age 12 to 55 years with a known pregnancy outcome between 2011 to 2020, and with ≥6 months continuous health plan enrollment prior to the estimated date of last menstrual period (LMP) through 30 days after pregnancy end date. Pregnancies with a history of hepatitis C identified from any medical encounter with relevant ICD-9/10-CM code, prior use of HCV treatment identified from pharmacy claims within 6 months prior to LMP were excluded. Each pregnancy was evaluated for the presence of an HCV test (HCV antibody, HCV RNA or HCV genotype) conducted between LMP to pregnancy end date using Common Procedural Terminology (CPT) codes. Secular trends in proportion of pregnancies with HCV screening and determinants for screening during the study period were examined.
Results: The study included 2,343,441 pregnancies among women with a mean age of 30.8 years (SD± 5.78). Among these pregnancies 318,713 (13.60%) had ≥1 HCV test. Nearly all (98.41%) HCV tests conducted were antibody tests. Factors associated with HCV testing include livebirth (OR = 3.72; 95%CI 3.68-3.76), prior diagnosis of human immunodeficiency virus (OR = 2.57; 95% CI 2.18-3.04), hepatitis B (OR = 1.43; 95% CI 1.27-1.61), substance use disorder (OR = 1.22; 95%CI 1.19-1.26) or cirrhosis (OR = 1.21; 95% CI 1.09-1.34). Most (86.0%) HCV testing occurred between 0 to 12 weeks from LMP, with peak testing occurring between 7 to 8 weeks of gestation (31.25%). The proportion of pregnancies that had an HCV test increased steadily from 9.95% in 2010 to 18.18% in 2020.
Conclusions: While prenatal screening of HCV is generally increasing, further analyses of adoption of HCV screening recommendations with more recent data are needed to monitor uptake and identify groups less likely to be tested and warrant further intervention. Determinants of failure to test, which translates into failure to introduce treatment and initiate follow-up among infants of infected mothers, need to be understood to effectively prevent unwanted maternal and infant outcomes resulting from active HCV infection.