Revealing disparities in hepatitis C care for reproductive-aged women to break cycle of viral transmission

Most pediatric cases of hepatitis C virus (HCV) infection are perinatal, meaning the virus is transmitted from birthing parent to child during pregnancy or birth, according to the Centers for Disease Control and Prevention. If left untreated, hepatitis C infection can lead to worse outcomes later in life, such as chronic liver disease, liver failure, and liver cancer. Identifying disparities in testing and treating hepatitis C among people of reproductive age with opioid use disorder can improve health outcomes for all birthing parents and children.

Researchers at Boston Medical Center (BMC) have analyzed racial and ethnic disparities using national data on hepatitis C care for reproductive-aged women with opioid use disorder. The findings are published in Clinical Infectious Diseases.

“Effective screening and treatment for hepatitis C virus in reproductive-aged women is a powerful tool for breaking the cycle of transmission. By identifying and treating hepatitis C early, we can significantly reduce the risk of severe disease and prevent transmission to children, ultimately improving both maternal and infant health outcomes,” says Rachel Epstein, MD, MScE, senior author on the paper and an infectious disease clinician-scientist at Boston Medical Center (BMC).

The team found that Asian and Black individuals were 25% less likely than white individuals to be tested for hepatitis C, and American Indian/Alaska Native women were tested more often than any other racial or ethnic group. Additionally, fewer than 10% of women with opioid use disorder who tested positive for hepatitis C virus received treatment for the virus. Identifying and treating all reproductive-aged women can reduce the risk of poor health outcomes, both for themselves and their children.

“If we aren’t testing people, we can’t connect them to care and that can lead to significant complications, including transmitting the virus. Treating women postpartum or during pregnancy for hepatitis C infections, with appropriate discussion of the risks and benefits, is important to improving health outcomes for everyone,” says Breanne Biondi, MPH, first author on the paper and Ph.D. candidate at Boston University School of Public Health.

At BMC, clinicians are already working to minimize disparities in hepatitis C care. Project RESPECT has piloted a program where obstetricians, family medicine physicians, and pharmacists work together to integrate hepatitis C treatment into postpartum care to help prevent transmission in future pregnancies.

Additionally, pediatric infectious disease clinicians at BMC are working to improve both testing rates in exposed infants and treatment rates in parents by consulting on all birthing parents with hepatitis C infection during their delivery hospital stay and helping link both the infant and parent(s) to care. BMC has seen improved treatment rates since this program started, with women initiating treatment at more than twice the rate they were previously.

“We need to determine what disparities occur in hepatitis C screening and treatment and learn how to overcome them to ensure that all people have equitable access to care. By prioritizing equity in our health care approaches, we can ensure that parents and their children have the opportunity for timely diagnosis and effective treatment,” says BMC clinician-scientist Epstein, who is also an assistant professor of medicine and pediatrics at Boston University Chobanian & Avedisian School of Medicine.