Hepatitis C-exposed infants more likely to be screened under early-testing policies
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Key takeaways:
- Screening at age 2 months was associated with better hepatitis C testing completion rates than other strategies.
- Completion rates varied significantly by a pediatrician’s testing policy.
When it comes to screening perinatally exposed infants for hepatitis C virus, the earlier the better, a study showed.
Specifically, researchers found that exposed infants were more likely to be screened for HCV if their pediatrician’s policy was to test them at 2 months, according to study results published in Pediatrics. The rates when down as the length of pediatricians’ testing policies increased.
Danica E. Kuncio, MPH and Emily J. Waterman, MPH, who conducted the study with colleagues at the Philadelphia Department of Public Health, told Healio that they have been actively tracking perinatal HCV in Philadelphia since “before 2016, because of observed increases in HCV infections among people of childbearing potential,” and found low rates of screening for HCV among children who were perinatally exposed.
“We have a program that identifies pregnant or recently postpartum people living with HCV and works with them, their health care providers and their infant’s pediatrician to ensure children are tested for HCV, yet testing isn’t always completed,” Kuncio and Waterman told Healio in joint written responses. “This could lead to undiagnosed chronic HCV infections that can be unknowingly transmitted and could cause long-term health issues, such as liver disease and cancer.”
For the study, the researchers “looked at factors associated with successful testing, including demographics, perinatal hepatitis C testing policy followed by the pediatrician, and pediatric care markers,” Kuncio and Waterman said. “We performed chi-squared and logistic regressions to assess associations.”
According to the study, HCV-positive pregnant people gave birth to 457 children between 2016 and 2020, of whom 67.2% were tested for HCV according to recommendations and 17.2% were inadequately tested.
Children were more likely to be tested if born to a pregnant person with HIV coinfection (P = .007), if they always adhered to the schedule for vaccinations (P < .001) and if they attended an 18-month well visit (P < .001).
HCV testing completion rates varied significantly by pediatrician’s testing policy: 90.9% of infants were tested if the policy was to screen at 2 months, 79.6% if the policy was to screen at 2 to 12 months, 61.9% for a 12-month policy and 58.5% if the policy was 18 months (P < .001).
“These findings are in line with the CDC’s 2023 recommendation to test with HCV RNA between 2 and 6 months of age,” Kuncio and Waterman said. “Other recommendations support testing with anti-HCV antibody at 18 months of age, which shows an increased rate of loss to follow-up and uncompleted testing confirmed by our analysis.”
The researchers said they anticipated the findings.
“We know engagement in pediatric care is better in the first year of life for these children, and transience or changes in guardianship or pediatrician occur for many of them over time,” Kuncio and Waterman said. “This leads to drops in HCV screening being performed. However, it was encouraging to see the associations persist in the data, particularly when we looked at immunization and factors related to care engagement.”
To screen infants, a pediatrician must know about the exposure, which requires communication between prenatal care providers, the birthing person and the pediatrician, they noted.
“Children do not always remain in consistent care of a pediatrician who is aware of the HCV exposure, or there are competing priorities to completing the testing,” Kuncio and Waterman said.
They recommended that pediatricians test as early as they can for HCV in perinatally exposed infants — after 2 months with an HCV RNA test — and said they are interested in future study on the issue.
“We acknowledge that there are other factors associated with gaps in testing, and future analyses may study those,” Kuncio and Waterman said . “In addition, it would be wonderful to see research about successful strategies employed by clinicians to complete this testing.”
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