(31) Hepatitis C Virus Care Linkage for Peripartum Individuals with Opioid Use Disorder

Background & Introduction: Hepatitis C virus (HCV) is prevalent among pregnant individuals with opioid use disorder (OUD)(1), yet many people do not receive HCV treatment despite the availability of direct-acting antivirals (DAAs). Co-located OUD and obstetric care may improve HCV screening, diagnosis, and treatment (2,3), but barriers like continued substance use and fragmented healthcare remain. Little is known about factors influencing postpartum DAA treatment uptake in this population. The objective of this study was to describe a linkage to care (LTC) model for Hepatitis C Virus (HCV) screening and diagnosis in pregnancy and postpartum HCV treatment among individuals with OUD. Among HCV-diagnosed individuals, we compared characteristics of those who did and did not receive postpartum DAA treatment.

Methods: We conducted a retrospective cohort study individuals with a pregnancy episode between 2016 and 2021 receiving co-located OUD and obstetric care at a single academic medical center. LTC endpoints were the proportion of individuals who: (1) were screened with HCV antibody or viral load, (2) diagnosed with HCV, (3) prescribed DAA treatment, (4) completed DAA treatment,), (5) tested for and (6) had a sustained viral response at 12 weeks (SVR12) after completing DAA treatment. We compared characteristics HCV-positive individuals who did and did not receive DAA treatment using chi-squared and fisher’s exact tests.

Results: From 2016-2021, 399 pregnant individuals with OUD were identified; 382 (95.6%) were screened for HCV and 70 (17.5%) were diagnosed with HCV infection. Of the 70 individuals with HCV, 22 (31.4%) were prescribed DAA and 18 (25.7%) had SVR12. Four individuals did not return for SVR12 testing. Among the 22 individuals prescribed DAA postpartum, 15 (68.2%) received treatment from obstetric clinicians and 7 (31.8%) through referral to liver specialist. Compared to HCV-positive individuals who did not receive DAA treatment, a higher proportion of those who received DAA treatment were taking buprenorphine at delivery (63.6% vs. 45.8%, p< 0.05) and a lower proportion were using non-prescribed substances in the postpartum period (18.2% vs. 50.0%, p=0.23).

Conclusion & Discussion: Co-located OUD and obstetric care resulted in high rates of HCV screening and diagnosis during pregnancy, with promising LTC for postpartum DAA treatment. Potential areas for improvement in our LTC model include partnerships with outpatient treatment programs for those receiving methadone and outreach for those with continued substance use. A limitation of the study is its use of billing codes and clinic notes to ascertain variables as information contained in the medical record is not documented for research purposes. Despite this limitation, our results suggest that expanding linkage to care models, particularly outreach for individuals on methadone and those with continued substance use, could improve outcomes and reduce HCV-related morbidity among pregnant and postpartum people.

References: 1. Ko JY. National trends in hepatitis C infection by opioid use disorder status among pregnant women at delivery hospitalization—United States, 2000–2015. MMWR Morb Mortal Wkly Rep. 2019;68
2. Epstein RL, Moloney C, Garfinkel J, et al. Enhancing linkage to hepatitis C virus treatment following pregnancy in women identified during perinatal care. Hepatology Communications. 2021;5(9):1543-1554.
3. Chappell CA, Stewart E, Laird HJ, et al. Postpartum Treatment for Chronic Hepatitis C Virus Among People With Opioid Use Disorder: A Prospective Pilot Clinical Trial. J Addict Med. 9900;