PMID- 33934324
OWN - NLM
STAT- MEDLINE
DCOM- 20220103
LR  - 20220103
IS  - 1098-8785 (Electronic)
IS  - 0735-1631 (Linking)
VI  - 38
IP  - 11
DP  - 2021 Sep
TI  - Pragmatic Experience with Risk-based versus Universal Hepatitis C Screening in 
      Pregnancy: Detection of Infection and Postpartum Linkage to Care.
PG  - 1109-1116
LID - 10.1055/s-0041-1728827 [doi]
AB  - OBJECTIVE: Despite the Centers for Disease Control and Prevention (CDC) and U.S. 
      Preventive Services Task Force (USPSTF) recommending universal hepatitis C virus 
      (HCV) screening in pregnancy Society for Maternal-Fetal Medicine (SMFM) and 
      American College of Obstetricians and Gynecologists (ACOG) continue to endorse 
      risk-based screening for HCV in pregnancy. We hypothesized that universal 
      screening is associated with increased HCV diagnosis and postpartum linkage to 
      HCV care compared with risk-based screening. STUDY DESIGN: This retrospective 
      cohort study included pregnant women screened for HCV at a single tertiary-care 
      center. We defined two cohorts: women managed with risk-based (January 
      2014-October 2016) or universal HCV screening (November 2016-December 2018). 
      Screening was performed with ELISA antibody testing and viremia confirmed with 
      HCV ribonucleic acid (RNA) polymerase chain reaction (PCR). Primary outcomes were 
      the rate of HCV screen positivity and postpartum linkage to care. RESULTS: From 
      2014 to 2018, 16,489 women delivered at our institution, of whom 166 screened 
      positive for HCV. A total of 7,039 pregnant women were screened for HCV: 266 with 
      risk-based and 6,773 with universal screening; 29% (76/266) were positive HCV 
      antibody screening (HCVAb + ) in the risk-based cohort and 1.3% (90/6,773) in the 
      universal cohort. HCVAb+ women in the risk-based cohort were more likely to have 
      a positive drug screen. Only 69% (62/90) of HCVAb+ women in the universal cohort 
      met the criteria for risk-based testing. Of the remaining 28 women, 6 (21%) had 
      active viremia (HCV RNA(+)). Of the 166 HCVAb+ women, 64% (103/166) were HCV 
      RNA(+)-51 of 266 (19%) in the risk-based and 52 of 6,773 (0.8%) in the universal 
      cohort. Of HCVAb+ women, 75% (125/166) were referred postpartum for HCV 
      evaluation and 27% (34/125) were linked to care. Only 9% (10/103) of women with 
      viremia initiated treatment within 1 year of delivery. CONCLUSION: Universal HCV 
      screening in pregnancy identified an additional 31% of HCVAb+ women compared with 
      risk-based screening. Given low rates of HCV follow-up and treatment regardless 
      of screening modality, further studies are needed to address barriers to 
      postpartum linkage to care. KEY POINTS: . Ideal screening for HCV in pregnancy is 
      unknown.. . We explore screening strategies in pregnancy to linkage to HCV care.. 
      . Regardless of screening strategy there is low rates of postpartum linkage to 
      HCV care..
CI  - Thieme. All rights reserved.
FAU - Bushman, Elisa T
AU  - Bushman ET
AD  - Center for Women's Reproductive Health, University of Alabama at Birmingham, 
      Birmingham, Alabama.
AD  - Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 
      Birmingham, Alabama.
FAU - Subramani, Lakshmi
AU  - Subramani L
AD  - University of Alabama Birmingham School of Medicine, Birmingham, Alabama.
FAU - Sanjanwala, Aalok
AU  - Sanjanwala A
AD  - Center for Women's Reproductive Health, University of Alabama at Birmingham, 
      Birmingham, Alabama.
AD  - Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 
      Birmingham, Alabama.
FAU - Dionne-Odom, Jodie
AU  - Dionne-Odom J
AD  - Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama.
FAU - Franco, Ricardo
AU  - Franco R
AD  - Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama.
FAU - Owen, John
AU  - Owen J
AD  - Center for Women's Reproductive Health, University of Alabama at Birmingham, 
      Birmingham, Alabama.
AD  - Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 
      Birmingham, Alabama.
FAU - Subramaniam, Akila
AU  - Subramaniam A
AD  - Center for Women's Reproductive Health, University of Alabama at Birmingham, 
      Birmingham, Alabama.
AD  - Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 
      Birmingham, Alabama.
LA  - eng
PT  - Journal Article
DEP - 20210502
PL  - United States
TA  - Am J Perinatol
JT  - American journal of perinatology
JID - 8405212
RN  - 0 (Antiviral Agents)
RN  - 0 (Hepatitis C Antibodies)
SB  - IM
MH  - Adult
MH  - Antiviral Agents/therapeutic use
MH  - Centers for Disease Control and Prevention, U.S.
MH  - Female
MH  - Hepacivirus/*genetics/isolation & purification
MH  - Hepatitis C/diagnosis/drug therapy/*epidemiology
MH  - Hepatitis C Antibodies/blood
MH  - Humans
MH  - Mass Screening/*methods/standards
MH  - Postpartum Period
MH  - Pregnancy
MH  - Pregnancy Complications, Infectious/diagnosis/drug therapy/*epidemiology
MH  - Retrospective Studies
MH  - United States
MH  - Young Adult
COIS- None declared.
EDAT- 2021/05/03 06:00
MHDA- 2022/01/04 06:00
CRDT- 2021/05/02 21:10
PHST- 2021/05/03 06:00 [pubmed]
PHST- 2022/01/04 06:00 [medline]
PHST- 2021/05/02 21:10 [entrez]
AID - 10.1055/s-0041-1728827 [doi]
PST - ppublish
SO  - Am J Perinatol. 2021 Sep;38(11):1109-1116. doi: 10.1055/s-0041-1728827. Epub 2021 
      May 2.