A safety net health system in Atlanta, Georgia, successfully implemented the 2020 recommendations of the US Centers for Disease Control and Prevention (CDC) that call for universal screening hepatitis C (HCV) screening for all persons 18 years of age and older and for all pregnant women with each pregnancy, said authors of a poster presentation at Digestive Disease Week 2023.

The authors observed that women of childbearing age “make up an increasingly higher percentage of new HCV infections and the rate of HCV infection in pregnant women is rising.”

The Grady Health System in Atlanta has had an active, opt-out HCV screening program since 2012, the authors noted, which has shown 9% prevalence of HCV antibody positivity and a 4.7% prevalence of chronic infection. However, the authors stated, OB/GYN clinics had not been specifically targeted for screening.

“Grady Liver Clinic and OB/GYN teams collaborated to design and implement a universal HCV screening workflow that included the addition of the HCV antibody with reflex to HCV RNA PCR test to the existing prenatal laboratory test panel,” the authors explained. “Following the program launch, HCV laboratory reports were reviewed to determine the number of patients tested and the prevalence of HCV exposure (HCV antibody positivity) and active infection (HCV RNA positivity). Charts were reviewed for patient demographics and pregnancy status.”

During the study period July 2020 to October 2022, the clinics screened 6,107 individuals for HCV in the OB/GYN clinics, finding 79 (1.3%) patients who were HCV antibody positive and 16 (0.3% of total tested, 20% of antibody positive) who were HCV RNA positive. “HCV antibody prevalence was significantly lower in comparison to a cohort of 23,666 individuals screened in GHS outpatient clinics (excluding OB/GYN) over the same period (3.54%, p=0.025),” the authors reported. “In the OB/GYN clinics, patients with HCV antibody positivity were all female and primarily pregnant, born after the year 1965, Black/African American, and non-Hispanic. Pregnant patients made up 75% of antibody positive individuals and 81% of patients with active infection. Of the patients with active infection, 25% used IV drugs.”

The researchers found that the prevalence of active HCV infection in the tested population was low, but observed that “most patients with chronic HCV were pregnant, and drug use was common. Our findings suggest that universal HCV screening is an important tool to diagnose previously undiagnosed HCV infections.”

—Rebecca Mashaw

Reference:

Lue N, Lom J, Park B, et al. Successful implementation of universal HCV screening at a safety-net hospital's obstetrics and gynecology clinics. ePoster. Presented at: Digestive Disease Week. May 6, 2023. Chicago, IL.