Universal hepatitis C screening updates have influenced testing numbers, and resulted in a gradual increase for all women with a pronounced increase in pregnant women.
Hepatitis C virus (HCV) testing in pregnant women increased significantly over time after the universal hepatitis C screening guidelines were updated in 2020. The findings were published in JAMA.1
“Screening for HCV per 1000 person-years increased from 52 to 117 tests among pregnant women and 16 to 24 tests among nonpregnant women from 2014 to 2019 (during 461 178 and 21 209 097 person-years of follow-up, respectively). After guidance change, screening per 1000 person-years increased from 141 to 253 among pregnant women and from 29 to 37 among nonpregnant women (during 289 888 and 13 129 610 person-years of follow-up, respectively),” the study authors wrote.1
The investigators noted there was not a significant increase immediately after the guidelines, but it did have greater testing uptake over time.
“The HCV screening rate increased by 21 HCV tests per 1000 person-years (95% CI, 16-26; P < .001) per 6-month interval postguidance vs preguidance change in pregnant compared with nonpregnant women,” the investigators wrote.1 By the end of 2022, 38.73% of pregnant women were tested at least once. For nonpregnant women, only 8.67% of women had been tested1.
Although there were gains made overall, especially in the pregnant women cohort, there were less than ideal testing numbers overall.
“The increasing but suboptimal HCV screening suggests innovative strategies are needed to improve HCV diagnosis and treatment. Perinatal care is a unique health care touchpoint and could be a key time to implement the national HCV elimination plan,” the study authors wrote1
The investigators utilized a multiple-group interrupted time series analysis where they compared hepatitis C screening rates for pregnant vs nonpregnant women for each 6-month period before (January 2014 to December 2019) and after (July 2020 to December 2022), when the 2020 guidelines were implemented. The did not use the time period between January and June of 2020, due to the pandemic.1
Learn more: AASLD/IDSA Develop a New Algorithm for Hepatitis C Point of Care Testing and Treatment
In the updated guidelines, The Centers for Disease Control and Prevention (CDC) calls for all people 18 years and older and all pregnant women during each pregnancy to get tested for HCV.2 The federal agency also recommends periodic testing for people in certain high-risk groups such as those who inject drugs or those with selected medical conditions, including people who receive maintenance hemodialysis. 2
HCV testing per 1000 person-years more than doubled in pregnant women from 52 to 117 tests before the 2020 guideline change, and rose even more dramatically afterward—from 141 to 253 tests.
Nonpregnant women also saw increases, but much smaller—going from 16 to 24 (before) and 29 to 37 (after).
The data showed no sudden spike in testing rates right after the guideline update.
Testing remains a significant public health campaign, especially as HCV can remain asymptomatic in many individuals. According to the CDC, nearly 1 in 3 people with hepatitis C are unaware of their infection status, and approximately 75%–85% of people with hepatitis C don’t have symptoms.2
There is also a newer test-and-treat concept where people get screened for hepatitis C—and for those who test positive for the virus—are given medication in the same visit. This concept looks to expedite the process of getting people into the continuum of care.
