Recently, the American College of Obstetrics and Gynecology joined the CDC in recommending universal hepatitis C virus (HCV) screening of pregnant people. Universal HCV screening is hypothesized to increase the detection of HCV among pregnant people, resulting in fewer undetected perinatal HCV transmissions. Screening and case detection of HCV during risk-based vs. universal HCV screening among pregnant people attending care in Western Pennsylvania was compared.
Universal HCV screening was implemented in June 2020 using a Best Practice Alert in the electronic medical records (EMR) which provided a reminder if HCV testing was not ordered with the new OB panel and reflex testing for HCV RNA if IgG positive. HCV detection was compared using Fisher’s exact test for all pregnant people presenting for prenatal care within one health system during two 12-month time periods: 1) risk-based HCV screening for 12,142 pregnant people (January 1-December 31, 2019) and 2) universal HCV screening for 12,588 pregnant people (July 1, 2020-June 30, 2021). The EMRs were reviewed for HCV testing nine months before and after initiation of prenatal care. Data from January to June 2020 was excluded due to concerns about poor health care utilization and disruptions in operations due to COVID-19.
Universal HCV screening resulted in an increase in HCV IgG screening from 23% to 81% of people entering obstetrical care (p<0.001). The positivity rate of HCV IgG was higher among those who were tested using risk-based vs. universal screening (5.4% vs. 2.3%) (p<0.001). However, the prevalence of HCV IgG+ people was lower in the overall population using risk-based vs. universal screening (1.2% vs 1.9%) (p<0.001). Utilization of reflex HCV testing resulted in an increase in active HCV detected from 11 (0.091%) to 85 (0.68%) of the obstetrical population during the two 12-month monitoring periods (p<0.001). Given the HCV perinatal transmission rate of 5.8%, an additional 4 infants with perinatal HCV in 12 months were identified with universal screening that had previously gone undetected with risk-based screening within our system.
Risk-based HCV screening is insensitive for HCV detection within the general obstetric population. Our findings strongly support universal HCV screening of pregnant people not only to ensure that the pregnant person is linked to treatment, but also to ensure detection of all cases of perinatal HCV transmission.