Hepatitis C Screening in Mothers and Infants Exposed to Opioids

Bell, Rick; Wolfe, Isabel; Cox, D. F.; Thakarar, Kinna; Lucas, Lee; Craig, Alexa

doi:10.1542/hpeds.2018-0225

Cited by 15 publications

(9 citation statements)

References 7 publications

(3 reference statements)

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“…Despite growing knowledge regarding the risks of perinatal transmission, the true burden of perinatally acquired HCV remains unknown. There are clear guidelines from the IDSA/AASLD recommending that HCV-exposed infants receive an HCV antibody test after 18 months of age or HCV RNA test after 2 months old [ 36 ]; however, multiple studies evaluating healthcare utilization have shown that HCV-exposed infants are not routinely linked to testing for HCV [ 18 , 37 – 42 ]. For example, a recent study from a large health center estimated that at least two-thirds of perinatally acquired HCV cases were missed due to lack of recognition of risk factors and inconsistencies in documenting maternal infection in the child’s medical record [ 37 ].…”

Section: Perinatal Transmission and Significance For Pediatric Popula...mentioning

confidence: 99%

Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

Curtis

Chappell

2023

Curr HIV/AIDS Rep

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Purpose of Review In the context of the opioid epidemic, hepatitis C virus (HCV) infection prevalence is increasing among women of reproductive age. Pregnant people with HIV/HCV coinfection may be at increased risk of adverse pregnancy and neonatal outcomes, although research in this key population is lacking. Recent Findings Treatment with directly acting antivirals (DAAs) has transformed the clinical care for most patients with HCV. However, pregnant people were excluded from trials of these medications. A recent phase I study has shown promise with excellent safety profile for ledipasvir-sofosbuvir; demonstrating no episodes of perinatal transmission, 100% sustained virologic response, and no safety concerns. Summary Pregnancy represents a time of maximal interaction with the healthcare system and therefore an ideal window of opportunity to cure HCV. Current observational data regarding pregnant people who are co-infected with HCV and HIV suggest poor outcomes such as increased risk of preterm birth; however, there are no prospective and well-controlled studies to fully understand the impact of HIV/HCV coinfection on pregnancy. Phase 1 studies suggest that DAAs are well-tolerated and effective during pregnancy. Only through large, prospective clinical trials will we be able to understand the interaction of HCV and HIV during pregnancy and to evaluate safety and efficacy of DAAs in this key population.

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Section: Perinatal Transmission and Significance For Pediatric Popula...mentioning

confidence: 99%

Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

Curtis

Chappell

2023

Curr HIV/AIDS Rep

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“…[16][17][18] This creates a gap in timing from diagnosis to treatment and increases the potential of HCV-positive patients and their infants being lost to follow-up. 6,16 Previous studies in Maine used Medicaid claims data 19 and electronic medical record (EMR) and Health Info Net (a large nonprofit interpractice system database for record sharing) 10 to track pregnant people with OUD; however, tracking follow-up care for mother-infant dyads was suboptimal. 10 Separate postpartum and pediatric care, loss of health insurance after delivery, complex substance use and mental health disorders, and variations in legal custody of the infant result in fragmented care delivery and inadequate follow-up.…”

mentioning

confidence: 99%

“…6,16 Previous studies in Maine used Medicaid claims data 19 and electronic medical record (EMR) and Health Info Net (a large nonprofit interpractice system database for record sharing) 10 to track pregnant people with OUD; however, tracking follow-up care for mother-infant dyads was suboptimal. 10 Separate postpartum and pediatric care, loss of health insurance after delivery, complex substance use and mental health disorders, and variations in legal custody of the infant result in fragmented care delivery and inadequate follow-up. 10 There are few examples of effective approaches to tracking HCV follow-up and treatment outcomes for perinatal patients and their infants across a wide service area.…”

mentioning

confidence: 99%

“…7,8 Prior research suggests that a risk-based approach to testing and diagnosis of HCV infection is inadequate, placing pregnant people and their partners at a continued risk of developing HCV, as well as their perinatally exposed infants. 9,10 Expanding testing and improving connection to care are key activities for achieving the US Centers for Disease Control and Prevention's (CDC's) goal to eliminate HCV transmission in pregnant people and their infants.…”

mentioning

confidence: 99%

“…10 Separate postpartum and pediatric care, loss of health insurance after delivery, complex substance use and mental health disorders, and variations in legal custody of the infant result in fragmented care delivery and inadequate follow-up. 10 There are few examples of effective approaches to tracking HCV follow-up and treatment outcomes for perinatal patients and their infants across a wide service area. The US CDC created a robust tracking program for perinatal people and their infants called Surveillance for Emerging Threats to Mothers and Babies Network for implementation in a multistate sample highly affected by HCV.…”

mentioning

confidence: 99%

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Hepatitis C Virus Cascade of Care Among Perinatal Patients in Maine Diagnosed With Opioid Use Disorder, 2015–2020

et al. 2022

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ObjectiveThis is a quality improvement project to determine the best process to identify and address gaps in care for perinatal patients in receiving appropriate hepatitis C virus (HCV) testing and treatment across the largest health system in Maine.Study DesignWe reviewed electronic medical record data between October 1, 2015, and February 1, 2020, to investigate rates of HCV testing and treatment among 916 perinatal patients with opioid use disorder across 8 hospitals using a “cascade of care” framework, a model used previously to identify gaps in care and treatment of chronic diseases.Main Outcome MeasureWe examined HCV testing and treatment rates along the cascade of care and patient characteristics associated with HCV antibody testing and treatment, separately, using log binomial regression models. Models were adjusted for age, residential distance to medical center, psychiatric diagnosis, and opioid agonist therapy at delivery.ResultsOf pregnant patients eligible for screening, 64% (582/916) received HCV antibody testing. Of 136 patients with active HCV infection, 32% (n = 43) received a referral for treatment, 21% (n = 28) were treated, and 13% (n = 18) achieved sustained virologic response. In the adjusted regression models, only opioid agonist therapy was associated with HCV antibody testing (adjusted risk ratio, 1.31; 95% confidence interval, 1.18–1.46), and no factors were significantly associated with receipt of treatment among HCV viremic patients.ConclusionLow referral and treatment rates signify the need for quality improvement interventions to improve coordination of care between multiple disciplines and practice settings to increase access to HCV treatment.

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Cost-Effectiveness of Strategies for Treatment Timing for Perinatally Acquired Hepatitis C Virus

Curtis,

Epstein,

Pei

et al. 2024

JAMA Pediatr

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ImportancePrevalence of chronic hepatitis C virus (HCV) infection among pregnant people is increasing in the US. HCV is transmitted vertically in 7% to 8% of births. Direct-acting antiviral (DAA) therapy was recently approved for children with HCV who are 3 years or older. The clinical and economic impacts of early DAA therapy for young children with HCV, compared with treating at older ages, are unknown.ObjectiveTo develop a state-transition model to project clinical and economic outcomes for children with perinatally acquired HCV to investigate the cost-effectiveness of treating at various ages.Design, Setting, and ParticipantsThe study team modeled the natural history of perinatally acquired HCV to simulate disease progression and costs of a simulated a cohort of 1000 US children with HCV from 3 years old through death. Added data were analyzed January 5, 2021, through July 1, 2022.InterventionsThe study compared strategies offering 8 weeks of DAA therapy at 3, 6, 12, or 18 years old, as well as a comparator of never treating HCV.Main Outcomes and MeasuresOutcomes of interest include life expectancy from 3 years and average lifetime per-person health care costs. Other clinical outcomes include cases of cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma (HCC).ResultsThe study team projected that treating HCV at 3 years old was associated with lower mean lifetime per-person health care costs ($148 162) than deferring treatment until 6 years old ($164 292), 12 years old ($171 909), or 18 years old ($195 374). Projected life expectancy was longest when treating at 3 years old (78.36 life years [LYs]) and decreased with treatment deferral until 6 years old (76.10 LYs), 12 years old (75.99 LYs), and 18 years old (75.46 LYs). In a cohort of 1000 children with perinatally acquired HCV, treating at 3 years old prevented 89 projected cases of cirrhosis, 27 cases of HCC, and 74 liver-related deaths compared with deferring treatment until 6 years old. In sensitivity analyses, increasing loss to follow-up led to even greater clinical benefits and cost savings with earlier treatment.Conclusions and RelevanceThese study results showed that DAA therapy for 3-year-old children was projected to reduce health care costs and increase survival compared with deferral until age 6 years or older. Measures to increase DAA access for young children will be important to realizing these benefits.

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Hepatitis C Screening in Mothers and Infants Exposed to Opioids

Cited by 15 publications

References 7 publications

Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

Evidence for Implementation: HIV/HCV Coinfection and Pregnancy

Hepatitis C Virus Cascade of Care Among Perinatal Patients in Maine Diagnosed With Opioid Use Disorder, 2015–2020

Cost-Effectiveness of Strategies for Treatment Timing for Perinatally Acquired Hepatitis C Virus

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