HCV testing guidelines tied to increased screening for pregnant women

Key takeaways:

• HCV screening increased after guidelines updated to screen all adults and during each pregnancy.
• Screening rose for pregnant vs. nonpregnant women, with pregnant women tested almost twice as much as before.

Despite decreased population-level hepatitis C virus screening in 2020, guidance to test all adults and during every pregnancy was associated with increased HCV screening for pregnant women, according to a research letter published in JAMA.

In 2020, the CDC updated HCV guidelines to screen all adults at least once and to screen women during every pregnancy.

“Screening for HCV increased after the 2020 guidelines to universally screen all adults and pregnant people during each pregnancy. We compared screening rates for women who were pregnant vs. those who were not pregnant, and the increase was more significant for those who were pregnant,” Rachel L. Epstein, MD, MScE, infectious disease clinician-scientist at Boston Medical Center and associate professor of medicine at the Chobanian & Avedisian School of Medicine at Boston University, told Healio. “This implies that prenatal care could be a critical venue to help HCV elimination efforts.”
Epstein and colleagues analyzed electronic health records data from 759,591 pregnant and 24,066,400 nonpregnant women across 68 U.S. health care organizations from 2014 to 2022. Researchers compared HCV screening rates for pregnant and nonpregnant women for each 6-month period before and after the 2020 guidelines were released.

Overall, there were 79,231 incident HCV tests for pregnant women and 678,951 tests for nonpregnant women.

Before the CDC guidance updates, HCV screening increased from 52 to 117 tests per 1,000 person-years for pregnant women and from 16 to 24 tests per 1,000 person-years for nonpregnant women. After the guidance updates, HCV screening increased from 141 to 253 tests per 1,000 person-years for pregnant women and from 29 to 37 per 1,000 person-years for nonpregnant women. By December 2022, 38.73% of pregnant women and 8.67% of nonpregnant women received an HCV test, which is still well below guideline recommendations compared with about 90% of pregnant women tested for HIV by the end of the study.

“Prenatal care is an opportune time to apply HCV screening guidelines; test people while they are already having prenatal lab work done and follow up to link them to care to treat and cure their HCV,” Epstein told Healio. “Many young, relatively healthy people don’t see their primary care doctors often. Prenatal care is a great time to reach people and get them diagnosed and treated for their own health and to reduce transmission to future children, as well as to other people.”

Data show many people in the U.S. have HCV but are unaware of the diagnosis, Epstein said. With universal screening, everyone can be screened and treated if HCV is identified, she said.

“Education about the guidelines is key. They were published during the first COVID-19 peak in 2020 when outpatient clinics were closed for all but urgent visits generally, and people had many other worries. This likely slowed the uptake,” Epstein told Healio. “Secondly, how are we getting people tested? There has been a recent push for point-of-care testing, in general, which was recently approved in the U.S., but there are still many logistics to be figured out. Finding people where they are is also key — increasing screening in venues such as harm reduction sites and mobile health settings.”

For more information:

Rachel L. Epstein, MD, MScE, can be reached on Bluesky @RLEpsteinMD.bsky.social.