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

Abstract

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.

Hepatitis B and C in Pregnancy and Children: A Canadian Perspective

“…In a single study in British Columbia, among pregnant women, there was an uptake of 20.3% testing for anti-HCV among 109,983 samples, with an overall positivity rate of 2.5% [ 39 ]. Screening uptake has increased greatly and was 54.6% in 2019 [ 40 ]. More recently, we found than in the context of a universal screening pilot in 2020–2021, a prevalence of 0.4–0.55% was observed in two different urban regions in Ontario with 17,771 samples [ 41 ].…”

“…Despite the perceived efficiency and lower cost, risk-based prenatal HCV case-finding misses opportunities for engaging women into HCV care and likely contributes to the underestimation of the prevalence of infection in pregnant individuals [ 40 ]. The main caveat of risk-based approaches being reliance on provider knowledge and patient disclosure of stigmatized risk factors necessary to classifying individuals as at-risk and requiring HCV testing.…”