Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care
The US National Viral Hepatitis Action Plan calls for major efforts to expand hepatitis C virus (HCV) diagnosis and treatment; prenatal care settings are potential venues for expanding HCV testing. We aimed to characterize the HCV diagnostic cascade for women and infants and investigate factors asso...
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| Veröffentlicht in: | The Journal of pediatrics 2018-12, Vol.203, p.34-40.e1 |
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| container_end_page | 40.e1 |
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| container_title | The Journal of pediatrics |
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| creator | Epstein, Rachel L. Sabharwal, Vishakha Wachman, Elisha M. Saia, Kelley A. Vellozzi, Claudia Hariri, Susan Linas, Benjamin P. |
| description | The US National Viral Hepatitis Action Plan calls for major efforts to expand hepatitis C virus (HCV) diagnosis and treatment; prenatal care settings are potential venues for expanding HCV testing. We aimed to characterize the HCV diagnostic cascade for women and infants and investigate factors associated with linkage and follow-up.
We used electronic health records for a 10-year cohort of 879 women with opioid use disorder from an obstetric clinic serving women with substance use disorders.
Altogether, 744 women (85%) were screened for HCV; 510 (68%) were seropositive, of whom 369 (72%) had nucleic acid testing performed and of these 261 (71%) were viremic. Of 404 infants born to HCV-seropositive women, 273 (68%) were tested at least once for HCV, 180 (45%) completed the American Academy of Pediatrics-recommended perinatal HCV screening, and 5 (2.8%) were diagnosed with HCV infection and linked to care. More recent delivery date (2014-2015) was associated with maternal linkage to care (aOR, 2.5; 95% CI, 1.4-4.7). Maternal coinfection with HIV (aOR, 9.0; 95% CI, 1.1-72.8) and methadone maintenance therapy, compared with buprenorphine (aOR, 1.5; 95% CI, 0.9-2.5), were associated with higher rates of infant HCV testing.
HCV prevalence among pregnant women with opioid use is high and infant HCV screening is imperfect. Programmatic changes to improve both mother and infant follow-up may help to bridge identified gaps in the cascade to cure. |
| doi_str_mv | 10.1016/j.jpeds.2018.07.006 |
| format | Article |
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We used electronic health records for a 10-year cohort of 879 women with opioid use disorder from an obstetric clinic serving women with substance use disorders.
Altogether, 744 women (85%) were screened for HCV; 510 (68%) were seropositive, of whom 369 (72%) had nucleic acid testing performed and of these 261 (71%) were viremic. Of 404 infants born to HCV-seropositive women, 273 (68%) were tested at least once for HCV, 180 (45%) completed the American Academy of Pediatrics-recommended perinatal HCV screening, and 5 (2.8%) were diagnosed with HCV infection and linked to care. More recent delivery date (2014-2015) was associated with maternal linkage to care (aOR, 2.5; 95% CI, 1.4-4.7). Maternal coinfection with HIV (aOR, 9.0; 95% CI, 1.1-72.8) and methadone maintenance therapy, compared with buprenorphine (aOR, 1.5; 95% CI, 0.9-2.5), were associated with higher rates of infant HCV testing.
HCV prevalence among pregnant women with opioid use is high and infant HCV screening is imperfect. Programmatic changes to improve both mother and infant follow-up may help to bridge identified gaps in the cascade to cure.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2018.07.006</identifier><identifier>PMID: 30170857</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Boston - epidemiology ; Cohort Studies ; Coinfection ; Continuity of Patient Care - statistics & numerical data ; Female ; Hepatitis C - diagnosis ; Hepatitis C - transmission ; HIV Infections - epidemiology ; Humans ; Infant, Newborn ; Infectious Disease Transmission, Vertical ; linkage to care ; Neonatal Screening ; Opiate Substitution Treatment - statistics & numerical data ; Opioid-Related Disorders - drug therapy ; Opioid-Related Disorders - epidemiology ; pediatric hepatitis C ; Pregnancy ; Pregnancy Complications, Infectious - diagnosis ; prenatal screening ; Registries ; vertical transmission</subject><ispartof>The Journal of pediatrics, 2018-12, Vol.203, p.34-40.e1</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c485t-d2cea55b6e10c9ca2091ae069286cf8ea8a76ce59c340a095c637755d07c4e7b3</citedby><cites>FETCH-LOGICAL-c485t-d2cea55b6e10c9ca2091ae069286cf8ea8a76ce59c340a095c637755d07c4e7b3</cites><orcidid>0000-0003-2831-8865</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022347618308990$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30170857$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Epstein, Rachel L.</creatorcontrib><creatorcontrib>Sabharwal, Vishakha</creatorcontrib><creatorcontrib>Wachman, Elisha M.</creatorcontrib><creatorcontrib>Saia, Kelley A.</creatorcontrib><creatorcontrib>Vellozzi, Claudia</creatorcontrib><creatorcontrib>Hariri, Susan</creatorcontrib><creatorcontrib>Linas, Benjamin P.</creatorcontrib><title>Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><description>The US National Viral Hepatitis Action Plan calls for major efforts to expand hepatitis C virus (HCV) diagnosis and treatment; prenatal care settings are potential venues for expanding HCV testing. We aimed to characterize the HCV diagnostic cascade for women and infants and investigate factors associated with linkage and follow-up.
We used electronic health records for a 10-year cohort of 879 women with opioid use disorder from an obstetric clinic serving women with substance use disorders.
Altogether, 744 women (85%) were screened for HCV; 510 (68%) were seropositive, of whom 369 (72%) had nucleic acid testing performed and of these 261 (71%) were viremic. Of 404 infants born to HCV-seropositive women, 273 (68%) were tested at least once for HCV, 180 (45%) completed the American Academy of Pediatrics-recommended perinatal HCV screening, and 5 (2.8%) were diagnosed with HCV infection and linked to care. More recent delivery date (2014-2015) was associated with maternal linkage to care (aOR, 2.5; 95% CI, 1.4-4.7). Maternal coinfection with HIV (aOR, 9.0; 95% CI, 1.1-72.8) and methadone maintenance therapy, compared with buprenorphine (aOR, 1.5; 95% CI, 0.9-2.5), were associated with higher rates of infant HCV testing.
HCV prevalence among pregnant women with opioid use is high and infant HCV screening is imperfect. Programmatic changes to improve both mother and infant follow-up may help to bridge identified gaps in the cascade to cure.</description><subject>Adult</subject><subject>Boston - epidemiology</subject><subject>Cohort Studies</subject><subject>Coinfection</subject><subject>Continuity of Patient Care - statistics & numerical data</subject><subject>Female</subject><subject>Hepatitis C - diagnosis</subject><subject>Hepatitis C - transmission</subject><subject>HIV Infections - epidemiology</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infectious Disease Transmission, Vertical</subject><subject>linkage to care</subject><subject>Neonatal Screening</subject><subject>Opiate Substitution Treatment - statistics & numerical data</subject><subject>Opioid-Related Disorders - drug therapy</subject><subject>Opioid-Related Disorders - epidemiology</subject><subject>pediatric hepatitis C</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Infectious - diagnosis</subject><subject>prenatal screening</subject><subject>Registries</subject><subject>vertical transmission</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kN1KwzAUx4Mobk6fQJC-QOtJ0yStoCD1Y4OBXqi34Sw91YytHUk38O3tnIreeHUu_l-cH2OnHBIOXJ3Pk_mKqpCkwPMEdAKg9tiQQ6FjlQuxz4YAaRqLTKsBOwphDgBFBnDIBgK4hlzqIZs8kncNdriInjw2YelCcG0TtXU0phV2rnMhKqMX59fhIrqh2jWueY26N4pKDBYr2lpL9HTMDmpcBDr5uiP2fHf7VI7j6cP9pLyexjbLZRdXqSWUcqaIgy0splBwJFBFmitb54Q5amVJFlZkgFBIq4TWUlagbUZ6Jkbsate7Ws-WVFlqOo8Ls_Juif7dtOjMX6Vxb-a13RiVypRL0ReIXYH1bQie6p8sB7Mla-bmk6zZkjWgTU-2T539nv3JfKPsDZc7A_XPbxx5E6yjxlLlPNnOVK37d-ADeyOMEQ</recordid><startdate>20181201</startdate><enddate>20181201</enddate><creator>Epstein, Rachel L.</creator><creator>Sabharwal, Vishakha</creator><creator>Wachman, Elisha M.</creator><creator>Saia, Kelley A.</creator><creator>Vellozzi, Claudia</creator><creator>Hariri, Susan</creator><creator>Linas, Benjamin P.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2831-8865</orcidid></search><sort><creationdate>20181201</creationdate><title>Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care</title><author>Epstein, Rachel L. ; Sabharwal, Vishakha ; Wachman, Elisha M. ; Saia, Kelley A. ; Vellozzi, Claudia ; Hariri, Susan ; Linas, Benjamin P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c485t-d2cea55b6e10c9ca2091ae069286cf8ea8a76ce59c340a095c637755d07c4e7b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Boston - epidemiology</topic><topic>Cohort Studies</topic><topic>Coinfection</topic><topic>Continuity of Patient Care - statistics & numerical data</topic><topic>Female</topic><topic>Hepatitis C - diagnosis</topic><topic>Hepatitis C - transmission</topic><topic>HIV Infections - epidemiology</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infectious Disease Transmission, Vertical</topic><topic>linkage to care</topic><topic>Neonatal Screening</topic><topic>Opiate Substitution Treatment - statistics & numerical data</topic><topic>Opioid-Related Disorders - drug therapy</topic><topic>Opioid-Related Disorders - epidemiology</topic><topic>pediatric hepatitis C</topic><topic>Pregnancy</topic><topic>Pregnancy Complications, Infectious - diagnosis</topic><topic>prenatal screening</topic><topic>Registries</topic><topic>vertical transmission</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Epstein, Rachel L.</creatorcontrib><creatorcontrib>Sabharwal, Vishakha</creatorcontrib><creatorcontrib>Wachman, Elisha M.</creatorcontrib><creatorcontrib>Saia, Kelley A.</creatorcontrib><creatorcontrib>Vellozzi, Claudia</creatorcontrib><creatorcontrib>Hariri, Susan</creatorcontrib><creatorcontrib>Linas, Benjamin P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Epstein, Rachel L.</au><au>Sabharwal, Vishakha</au><au>Wachman, Elisha M.</au><au>Saia, Kelley A.</au><au>Vellozzi, Claudia</au><au>Hariri, Susan</au><au>Linas, Benjamin P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>2018-12-01</date><risdate>2018</risdate><volume>203</volume><spage>34</spage><epage>40.e1</epage><pages>34-40.e1</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><abstract>The US National Viral Hepatitis Action Plan calls for major efforts to expand hepatitis C virus (HCV) diagnosis and treatment; prenatal care settings are potential venues for expanding HCV testing. We aimed to characterize the HCV diagnostic cascade for women and infants and investigate factors associated with linkage and follow-up.
We used electronic health records for a 10-year cohort of 879 women with opioid use disorder from an obstetric clinic serving women with substance use disorders.
Altogether, 744 women (85%) were screened for HCV; 510 (68%) were seropositive, of whom 369 (72%) had nucleic acid testing performed and of these 261 (71%) were viremic. Of 404 infants born to HCV-seropositive women, 273 (68%) were tested at least once for HCV, 180 (45%) completed the American Academy of Pediatrics-recommended perinatal HCV screening, and 5 (2.8%) were diagnosed with HCV infection and linked to care. More recent delivery date (2014-2015) was associated with maternal linkage to care (aOR, 2.5; 95% CI, 1.4-4.7). Maternal coinfection with HIV (aOR, 9.0; 95% CI, 1.1-72.8) and methadone maintenance therapy, compared with buprenorphine (aOR, 1.5; 95% CI, 0.9-2.5), were associated with higher rates of infant HCV testing.
HCV prevalence among pregnant women with opioid use is high and infant HCV screening is imperfect. Programmatic changes to improve both mother and infant follow-up may help to bridge identified gaps in the cascade to cure.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30170857</pmid><doi>10.1016/j.jpeds.2018.07.006</doi><orcidid>https://orcid.org/0000-0003-2831-8865</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Boston - epidemiology Cohort Studies Coinfection Continuity of Patient Care - statistics & numerical data Female Hepatitis C - diagnosis Hepatitis C - transmission HIV Infections - epidemiology Humans Infant, Newborn Infectious Disease Transmission, Vertical linkage to care Neonatal Screening Opiate Substitution Treatment - statistics & numerical data Opioid-Related Disorders - drug therapy Opioid-Related Disorders - epidemiology pediatric hepatitis C Pregnancy Pregnancy Complications, Infectious - diagnosis prenatal screening Registries vertical transmission |
| title | Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care |
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