Screening and evaluation of hepatitis C virus infection in pregnant women on opioid maintenance therapy: A retrospective cohort study

ABSTRACT

Background: The purpose of this study was to describe the delivery of prenatal care services to women with opioid use disorder (OUD) on opioid maintenance therapy at high risk for hepatitis C virus (HCV) infection. Methods: We conducted a retrospective cohort evaluation of 791 pregnant women with OUD from 2009 to 2012. HCV screening was defined as documentation of (a) an anti-HCV antibody test or (b) a provider discussion regarding a known HCV diagnosis during pregnancy. Multivariate logistic regression was used to identify predictors of HCV screening during pregnancy. Results: Among 791 pregnant women with OUD, 611 (77.2%) were screened for HCV infection and 369/611 (60.4%) were HCV positive. In multivariable analysis, patients who were married (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.29, 0.91), used buprenorphine (OR = 0.45; 95% CI = 0.28, 0.71), and were cared for by private practice providers (OR = 0.29; 95% CI = 0.19, 0.45) were significantly less likely to be screened. In contrast, patients who used benzodiazepines (OR = 1.72; 95% CI = 1.02, 2.92), intravenous (IV) opioids (OR = 6.15; 95% CI = 3.96, 9.56), had legal problems (OR = 2.23; 95% CI = 1.12, 4.45), had children not in their custody (OR = 1.81; 95% CI = 1.01, 3.24), and who had a partner with substance abuse history (OR = 2.38; 95% CI = 1.23, 4.59) were significantly more likely to be screened. Of 369 HCV-positive patients, a new diagnosis of HCV was made during pregnancy for 108 (29.3%) patients. Only 94 (25.5%) had HCV viral load testing, 61 (16.5%) had HCV genotype testing, and 38 (10.4%) received an immunization for hepatitis A. Although 285 (77.2%) patients were referred to hepatology, only 71 (24.9%) attended the consultation. Finally, only 6 (1.6%) patients received HCV treatment 1 year following delivery. Conclusions: Prenatal care approaches to HCV infection remain inconsistent, and the majority of patients diagnosed with HCV infection during pregnancy do not receive treatment after delivery.

KEYWORDS:

• Hepatitis C virus
• opioid dependence
• pregnancy
• prenatal care screening

Author contributions

E.E.K. contributed to the research conception, design, analysis, interpretation of the results, and writing of the manuscript. S.L.Z., V.K.R., and E.B.S. contributed to the research conception, design and writing of the manuscript. S.Y.P. contributed to the analysis, interpretation of the results, and writing of the manuscript. S.L.D. contributed to the collection of data and writing of the manuscript.

Funding

This study was funded in full by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR000146 (Dr. Krans). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Rustgi is a consultant and advisory board member for AbbVie, Inc., and Merck and receives research support from Gilead Sciences, Inc., and Hyperion. All other authors report no conflicts of interest.