Medicaid patients with opioid use disorder rarely receive postpartum HCV care
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Among Medicaid beneficiaries with opioid use disorder who were diagnosed with hepatitis C virus infection during pregnancy, less than 6% received care or medication within 6 months postpartum, according to data published in Obstetrics & Gynecology.
“The rate of HCV infections has been rising alongside the opioid crisis,” Marian Jarlenski, PhD, MPH, an associate professor of health policy and management and associate director of the CONVERGE research program for advancing gender equity in health at the University of Pittsburgh School of Public Health, told Healio.
Because there tends to be more frequent health care contact during pregnancy, patients with opioid use disorder (OUD) may have greater access to treatment for HCV, the researchers wrote.
However, “there were little data on HCV treatment postpartum among people identified with HCV infection during pregnancy,” Jarlenski said.
Jarlenski and colleagues used administrative data to identify 23,780 Medicaid beneficiaries with OUD who had a live or stillbirth between 2016 and 2019 in Delaware, Kentucky, Maine, North Carolina, Pennsylvania or West Virginia. These patients were followed until 60 days postpartum; a subset of 19,697 patients were followed until 6 months postpartum.
The researchers used regression modeling to predict the probability of HCV testing, HCV diagnosis and postpartum HCV follow-up care in each state.
Across the six states, models showed 70.3% (95% CI, 61.5%-79.1%) of patients with OUD were tested for HCV, with high heterogeneity between states. Of those tested, 30.9% (95% CI, 23.8%-38.1%) tested positive for HCV. Again, between-state heterogeneity was high.
The predicted probability for postpartum follow-up visits or medication was low among those who tested positive for HCV, with only 3.2% (95% CI, 2.6%-3.8%) and 5.9% (95% CI, 4.9%-6.9%) of patients receiving care at 60 days and 6 months, respectively.
“On one hand, the low follow-up rates were surprising,” Jarlenski said. “On the other hand, it can be difficult to make and attend specialty visits postpartum, especially for people who are continuing to need to manage their OUD.”
Moving forward, Jarlenski said the health care system needs to address the low rates of follow-up care.
“Medicaid expansion in the postpartum period provides an opportunity to address chronic conditions,” Jarlenski said. “Given the low rates of follow-up care we observed for HCV among patients with OUD and HCV identified in pregnancy, health care system changes are needed to facilitate follow-up care for HCV. These changes have to be patient-centered and sustainable for health care payers.”
According to the CDC, curative HCV therapy is not currently approved during pregnancy — only once the mother has given birth is it safe to begin treatment.
However, researchers are studying HCV therapy during pregnancy, Jarlenski added.
“Currently there are trials recruiting participants to study the safety of using direct-acting antivirals to treat HCV infection in pregnancy,” she said. “It will be very important to see those data. If demonstrated to be safe and effective, treatment in pregnancy would be a great option.”
References:
- CDC. Test for hepatitis C during every pregnancy. https://www.cdc.gov/knowmorehepatitis/hcp/Test-For-HepC-During-Pregnancy.htm. Accessed April 7, 2022.
- Jarlenski M, et al. Obstet Gynecol. 2022;doi:10.1097/AOG.0000000000004760.