Enhanced identification of maternal hepatitis C virus infection using existing public health surveillance systems

Gowda, Charitha; Kennedy, Samuel; Glover, Catherine; Prasad, Mona; Honegger, Jonathan R.

doi:10.1111/ppe.12481

Cited by 13 publications

(13 citation statements)

References 27 publications

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“…As mentioned above, there is risk for vertical transmission among younger women living with HCV who become pregnant. A number of population-based studies in the US have indicated that rising maternal and pediatric HCV prevalence is likely related to concomitant increasing opioid use among women of reproductive potential [ 3 , 36 – 38 ]. In the BC Hepatitis Testers Cohort, 61% of women with chronic HCV infection who were born after 1975 had histories of injection drug use and opiate use, among whom 50% had not been treated for HCV as of 2019.…”

Section: Discussionmentioning

confidence: 99%

Women in the 2019 hepatitis C cascade of care: findings from the British Columbia Hepatitis Testers cohort study

Pearce

Bartlett

et al. 2021

BMC Women's Health

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Background Women living with hepatitis C virus (HCV) are rarely addressed in research and may be overrepresented within key populations requiring additional support to access HCV care and treatment. We constructed the HCV care cascade among people diagnosed with HCV in British Columbia, Canada, as of 2019 to compare progress in care and treatment and to assess sex/gender gaps in HCV treatment access. Methods The BC Hepatitis Testers Cohort includes 1.7 million people who tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 2000 to 2019. Test results were linked to medical visits, hospitalizations, cancers, prescription drugs, and mortality data. Six HCV care cascade stages were identified: (1) antibody diagnosed; (2) RNA tested; (3) RNA positive; (4) genotyped; (5) initiated treatment; and (6) achieved sustained virologic response (SVR). HCV care cascade results were assessed for women, and an ‘inverse’ cascade was created to assess gaps, including not being RNA tested, genotyped, or treatment initiated, stratified by sex. Results In 2019, 52,638 people with known sex were anti-HCV positive in BC; 37% (19,522) were women. Confirmatory RNA tests were received by 86% (16,797/19,522) of anti-HCV positive women and 83% (27,353/33,116) of men. Among people who had been genotyped, 68% (6756/10,008) of women and 67% (12,640/18,828) of men initiated treatment, with 94% (5023/5364) of women and 92% (9147/9897) of men achieving SVR. Among the 3252 women and 6188 men not yet treated, higher proportions of women compared to men were born after 1975 (30% vs. 21%), had a mental health diagnosis (42% vs. 34%) and had used injection drugs (50% vs. 45%). Among 1619 women and 2780 men who had used injection drugs and were not yet treated, higher proportions of women than men used stimulants (64% vs. 57%), and opiates (67% vs. 60%). Conclusions Women and men appear to be equally engaged into the HCV care cascade; however, women with concurrent social and health conditions are being left behind. Treatment access may be improved with approaches that meet the needs of younger women, those with mental health diagnoses, and women who use drugs.

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Section: Discussionmentioning

confidence: 99%

Women in the 2019 hepatitis C cascade of care: findings from the British Columbia Hepatitis Testers cohort study

Pearce

Bartlett

et al. 2021

BMC Women's Health

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“…The rate of hepatitis C virus (HCV) infection has increased among pregnant women in recent years (150)(151)(152)(153). HCV screening should be performed for all pregnant women during each pregnancy, except in settings where the HCV infection (HCV positivity) rate is <0.1% (154)(155)(156).…”

Section: Hepatitis C Virusmentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,339

2,621

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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

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“…HCV testing in BC is estimated to be 3.5-fold higher than in the US, and our finding related to the declining number of positive tests among prenatally screened women in BC suggests that more who are at low-risk are being tested and/or that fewer women who are pregnant or planning pregnancy are at risk of HCV infection. Moreover, several population-based studies in the US have indicated that rising maternal and pediatric HCV prevalence is likely related to concomitant increasing opioid use among women of childbearing age [6,[29][30][31]. Future exploration into differences between women in BC who had a prenatal anti-HCV test vs. those who did not will help better understand the testing trends we have found in this study, especially to evaluate the utility of risk-based testing guidelines when it appears that more healthcare providers are opting to test women with lower risk.…”

Section: Discussionmentioning

confidence: 99%

Prenatal hepatitis C screening, diagnoses, and follow-up testing in British Columbia, 2008–2019

Pearce

Alvarez

et al. 2020

PLoS ONE

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Objective Current guidelines in British Columbia recommend prenatal screening for hepatitis C antibodies (anti-HCV) if risk factors are present. We aimed to estimate frequency of prenatal anti-HCV testing, new diagnoses, repeated and follow-up testing among BC women. Methods BC Centre for Disease Control Public Health Laboratory data estimated the number of BC women (assigned female at birth or unknown sex) aged 13–49 who received routine prenatal serological screening (HIV, hepatitis B, syphilis and rubella) from 2008–2019. Anti-HCV tests ordered the same day as routine prenatal screens were considered prenatal anti-HCV tests. Assessment of follow-up was based on HCV RNA and/or genotype testing within one year of new prenatal anti-HCV diagnoses. Results In 2019, 55,202 routine prenatal screens were carried out for 50,392 BC women. Prenatal anti-HCV tests increased significantly, from 19.6% (9,704/49,515) in 2008 to 54.6% (27,516/50,392) in 2019 (p<0.001). New prenatal anti-HCV diagnoses (HCV positive diagnoses at first test or seroconversions) declined from 14.3% in 2008 to 10.1% in 2019. The proportion of women with new prenatal anti-HCV diagnoses that were a result of a first HCV test declined from 0.3% (29/9,701) in 2008 to 0.03% (8/27,500) in 2019. For women known to be anti-HCV positive at the time of prenatal screening, the proportion who had a prenatal anti-HCV test increased from 35.6% in 2008 to 50.8% in 2019. Conclusion Prenatal anti-HCV testing increased substantially over the study period. However, new HCV diagnoses remained relatively stable, suggesting that a considerable proportion of BC women with low or no risk are being screened as part of prenatal care. The vast majority of women with new HCV diagnoses receive appropriate follow-up HCV RNA and genotype testing, which may indicate interest in HCV treatment. These findings contribute to the discussion around potential for prenatal anti-HCV screening in an effort to eliminate HCV.

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Enhanced identification of maternal hepatitis C virus infection using existing public health surveillance systems

Cited by 13 publications

References 27 publications

Women in the 2019 hepatitis C cascade of care: findings from the British Columbia Hepatitis Testers cohort study

Women in the 2019 hepatitis C cascade of care: findings from the British Columbia Hepatitis Testers cohort study

Sexually Transmitted Infections Treatment Guidelines, 2021

Prenatal hepatitis C screening, diagnoses, and follow-up testing in British Columbia, 2008–2019

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