(410) Implementation of Universal Hepatitis C Screening

To investigate the continuum of care, specifically postpartum follow-up and treatment, for patients with chronic, untreated hepatitis C after establishment of universal hepatitis C screening and a standardized management protocol.

Study Design:

This was a retrospective cohort study of patients who delivered at a large public hospital and were screened for hepatitis C. The standardized protocol included evaluation by a maternal fetal medicine specialist for a reactive hepatitis C antibody, a quantitative viral load, liver enzymes, and referral to hepatology in the third trimester if viremic. Electronic medical records were reviewed for laboratory results, hepatology referrals, follow-up, and treatment.

Results:

From March 1, 2024 through March 10, 2025, 8,971 individuals delivered and were screened for hepatitis C. Of these, 106 (1.2%) had positive hepatitis C antibody testing with 13 (0.14%) with detectable viremia. Ten (0.11%) were newly diagnosed with hepatitis C. Of viremic patients, 12 (92.3%) were referred to hepatology and 8 (66.7%) of referred patients presented for follow-up by 115 days postpartum. Of the 8 individuals seen by hepatology, 5 initiated treatment between 39 and 357 days postpartum. Ultimately, 3 completed a treatment course and the fourth remains on treatment. The fifth patient discontinued prior to completion due to loss of insurance. Of the 3 who did not initiate treatment, one deferred until breastfeeding completion and has not yet returned to care. Another patient was unable to start due to difficulties with prior authorization, and the last declined to start despite initially filling the prescription.

Conclusion:

Following universal screening for hepatitis C at a safety-net hospital, 1.4 per 1000 individuals had detectable viremia. Despite increased screening and detection of this treatable infection, significant barriers remain in place for treatment postpartum. These findings suggest a need to consider available safety data and opportunities for treatment during pregnancy in a high-risk patient population with significant barriers for postpartum treatment completion.