Universal HCV screening in pregnancy accelerates after 2020 screening guideline updates
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Following updated hepatitis C virus screening recommendations issued in 2020, HCV screening in pregnancy accelerated across the country, according to a retrospective cohort study published in Obstetrics & Gynecology.
However, despite the increase in screening following the recommendations from the CDC and the U.S. Preventive Services Task Force, disparities in HCV screening persisted between patients with commercial and Medicaid health insurance.
Prior to 2020, neither the CDC nor the USPSTF outlined specific HCV screening recommendations for pregnant people. The revised CDC and USPSTF guidelines advise that all pregnant people should be screened for HCV during each pregnancy, “except in settings in which the prevalence of HCV infection is less than 0.1%,” according to the study.
“We wanted to see whether or not the revised guidelines — which came out during the COVID-19 pandemic — had an impact in changing physician [HCV screening] ordering patterns,” Harvey W. Kaufman, MD, MBA, FCAP, a senior medical director at Quest Diagnostics in Secaucus, New Jersey, told Healio.
Kaufman and colleagues assessed the rate of HCV screening among pregnant patients aged 15 to 44 years who had obstetric panel testing done by Quest Diagnostics between January 2011 and June 2021. Given that the CDC and USPSTF updated their guidelines in March and April of 2020, respectively, the researchers defined two time periods in their study: before the recommendations were updated in quarter 1 of 2011 through quarter 1 of 2020, and after the recommendations were updated in quarter 2 of 2020 through quarter 2 of 2021.
Overall rate of HCV screening
Among 5,048,428 pregnant individuals, 3,765,931 (74.6%) were commercially insured and 1,282,497 (25.4%) were insured through Medicaid. During the study period, 23.3% of patients had an HCV screening test; the rate of screening increased from 16.6% in quarter 1 of 2011 to 40.6% in quarter 2 of 2021, the researchers wrote.
“[This] is a big improvement from the first quarter of 2011, but it’s a far cry from 95% or 100%,” Kaufman told Healio. “So, the call to action is for more and more doctors to pay heed to the guidelines and offer [HCV] screening to these women.”
Following the recommendation updates, the rate of HCV screening significantly increased (RR = 1.084; 95% CI, 1.075-1.093).
Of note, the COVID-19 pandemic did not hinder the increasing rate of screening, as Kaufman had expected.
“The pandemic was clearly front and center in terms of people’s attention, and a lot of other things fell to the wayside,” he said. “It was comforting that despite the pandemic, there was attention paid to these revised guidelines.”
Screening differences by insurance type
For pregnant patients with commercial insurance, the rate of HCV screening before the guideline updates was greater than the rate among pregnant patients with Medicaid insurance (25% vs. 18.4%; P < .001). After the updates, both the commercially insured and the Medicaid-insured groups experienced a significant increase in the rate of HCV screening (RR = 1.088; 95% CI, 1.078-1.099; and RR = 1.138; 95% CI, 1.116-1.161, respectively). However, patients with commercial insurance still had a higher rate of screening compared with those using Medicaid insurance.
“Historically, that was driven in large part because many Medicaid programs were hesitant to or put barriers into receiving the relatively expensive hepatitis C treatments,” Kaufman said. “As the barriers dropped, more women covered by Medicaid have been tested, but there is still a gap between women with commercial insurance vs. Medicaid.”
Kaufman emphasized that laboratories that have not adopted the CDC’s recommendation to perform an HCV RNA test to confirm a positive antibody test should do so.
As for the future, Kaufman suggested more research is needed on “the determinants of adherence or lack of adherence” to changes in clinical guidelines for HCV screening.
References:
- Moyer VA, et al. Ann Intern Med. 2013;doi:10.7326/0003-4819-159-5-201309030-00672.
- Kaufman HW, et al. Obstet Gynecol. 2022;doi:10.1097/AOG.0000000000004822.
- Smith BD, et al. MMWR Recomm Rep. 2012;61(RR04):1-18.
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