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Universal hepatitis C virus screening in pregnancy
HCV Testing Quadruples With Switch to Universal Screening in Pregnancy
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2022 CROI, February 12-16 and 22-24, 2022
Mark Mascolini
Switching from screening for HCV infection only in pregnant people judged at risk for HCV to screening everyone in a Pittsburgh health system's general obstetric population virtually quadrupled the HCV testing rate [1]. Universal HCV screening in pregnancy led to a 7.5-fold jump in detection of active HCV infection in pregnant people.
Researchers from the University of Pittsburgh noted that the opioid epidemic has ballooned prevalence of HCV infection in pregnant people. At the researchers' hospital, diagnostic coding indicates that HCV prevalence doubled from 2006 to 2016. This inflated prevalence heightens risk of infant HCV infection because the vertical HCV transmission rate stands at 5.8%.
HCV screening in pregnancy has multiple benefits for both mothers and neonates, the investigators proposed. For mothers it promotes high engagement in health care, takes advantage of unique maternal motivation, enhances linkage to HCV care, and prevents cirrhosis. For newborns it identifies all exposed infants, enables early diagnosis of perinatal HCV, promotes linkage to HCV care, and prevents cirrhosis.
Several provider groups and government agencies now recommend universal HCV screening in pregnancy, the Pittsburgh researchers noted, including the AASLD, IDSA, ACOG, the Society for Maternal-Fetal Medicine, the US Preventive Services Task Force, and the Centers for Disease Control and Prevention (CDC). The authors' institution, the University of Pittsburgh Medical Center, adopted universal HCV screening in pregnancy in June 2020.
The Pittsburgh team undertook this study to compare HCV screening and case detection rates with universal versus risk-based screening during pregnancy among people in care in western Pennsylvania. They included all pregnant patients who had their first prenatal care visit in the university health system, embracing both urban and rural communities. The risk-based screening period ran from January 1, 2019 to December 31, 2019. The analysis excluded the first 6 months of 2020 because of healthcare disruptions caused by the arrival of COVID-19. The universal screening period ran from July 1, 2020 to June 30, 2021. The researchers reviewed medical records for HCV testing 9 months before and after prenatal care began, then compared the two periods.
The risk-based group included 12,142 people and the universal group 12,588. Respective proportions of whites were 72% and 74%, blacks 19% and 17%, and Hispanics 2% and 2%. Nearly half of both groups (about 45%) used Medicaid or Medicare insurance, and similar proportions used commercial insurance.
While 23% of the risk-based screening group had HCV IgG testing, 81% of the universal group got IgG testing, nearly a quadrupling of the screening rate. Respective proportions who tested positive were 1.2% and 1.9%. Only 22% of the IgG-positive risk-based group went on to HCV RNA testing, compared with 95% of IgG-positive people in the universal screening group. With risk-based screening, 11 people (0.091%) tested positive for HCV RNA, compared with 85 people (0.68%) in the universal screening group, a 7.5-fold vault in proportions testing positive.
Estimating perinatal transmission of HCV in the two groups by applying the 5.8% transmission rate to 11 people with active HCV in the risk-based group and 85 with active HCV in the universal group, the researchers figured that only 1 infant with HCV would be identified with risk-based screening versus 5 infants with universal screening.
The Pittsburgh investigators concluded that risk-based HCV screening is insensitive and that universal HCV screening in pregnancy boosted the detection rate for active infection 7.5-fold. "Pregnancy is a time of high healthcare engagement," the researchers reminded colleagues, "and pregnant people must be included in the HCV elimination strategy. Universal HCV screening is a first step."
Reference
1. Chappell CA, Mayo SM, Grosko JA, et al. Universal hepatitis C virus screening in pregnancy. 2022 CROI, February 12-16 and 22-24, 2022. Abstract 27.
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