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From the Journals

HCV Screening Uptake in Pregnancy vs General Population

Researchers found that universal hepatitis C screening guidelines increased testing rates in pregnant women, but overall uptake remained low, particularly among nonpregnant women.

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Despite universal screening guidelines, just 38.73% of pregnant women and 8.67% of nonpregnant women were ever tested for the hepatitis C virus, according to a recent study.

In the study, published in JAMA, investigators evaluated hepatitis C virus (HCV) screening rates among pregnant and nonpregnant women following the 2020 universal screening guideline updates. The updated guidelines recommended one-time HCV screening for all adults and routine testing during each pregnancy. The investigators, led by Roshni P. Singh, of the Section of Infectious Diseases at Boston Medical Center, and colleagues, analyzed whether the updated recommendations led to differential screening uptake in these populations.

They used data from TriNetX LIVE, a nationwide electronic health record database comprising 68 U.S. health care organizations and over 115 million patients. A multiple group interrupted time series analysis assessed HCV screening rates among women aged 15 to 45 years across 6-month intervals prior to (January 2014 to December 2019) and following (July 2020 to December 2022) the guideline implementation. A washout period from January to June 2020 accounted for disruptions from the COVID-19 pandemic and guideline dissemination. The pregnancy cohort included women with an International Classification of Diseases, Tenth Revision delivery code within 8 months of the analysis period, while the control group consisted of nonpregnant women without a delivery code. Patients with preexisting HCV were excluded, and human immunodeficiency virus (HIV) screening rates served as a negative control.

Between 2014 and 2022, 79,231 incident HCV tests were recorded among pregnant women and 678,951 among nonpregnant women. HCV screening per 1,000 person-years increased from 52 to 117 in pregnant women and from 16 to 24 in nonpregnant women prior to the guideline change. Following implementation, screening rates rose from 141 to 253 among pregnant women and from 29 to 37 among nonpregnant women. By December 2022, 38.73% of pregnant women and 8.67% of nonpregnant women had undergone HCV testing compared with 90.42% of pregnant women who were screened for HIV.

Interrupted time series analysis indicated a significant increase in HCV screening among pregnant women, with an adjusted increase of 21 tests per 1,000 person-years (95% confidence interval = 16–26, P < .001) per 6-month interval postguidance compared with preguidance. No statistically significant changes in HIV screening trends were observed, indicating that the increase in HCV screening was specific to the guideline change.

Although HCV screening increased following the guideline change, uptake remained suboptimal, with only 38.73% of pregnant women and 8.67% of nonpregnant women getting tested. The inestigators noted that perinatal care could serve as an opportunity to advance national HCV elimination efforts.

Full disclosures can be found in the published study.