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Hepatitis C Cascade of Care Among Pregnant Women on Opioid Agonist Pharmacotherapy Attending a Comprehensive Prenatal Program

Abstract

Background Given the large increases in opioid use among pregnant women and associations with hepatitis C virus (HCV) infection, screening pregnant women who are on (opioid agonist) pharmacotherapy for HCV infection has potential to inform medical care for these mothers as well as their newborns. We investigated the HCV testing cascade among pregnant women on pharmacotherapy in order to describe exposure and infection rates and to identify opportunities that would improve care. Methods Secondary analyses of laboratory results were performed for HCV testing, including anti-HCV, viremia (RNA) and genotype. Information was abstracted from the medical records of women who were followed at a comprehensive prenatal care clinic for women with substance use disorders at the University of New Mexico. Results The sample included 190 pregnant women, of whom 188 were on pharmacotherapy (43.7% on buprenorphine and 55.3% on methadone); the remaining two had tested positive for heroin or prescription opioids. A total of 178 (93.7%) were tested for anti-HCV, 94 (98.9%) of whom were tested for RNA, and 41 (57.7%) were genotyped. Prevalence of exposure to HCV by anti-HCV results was 53.3%, and 37.3% were positive for HCV RNA indicating chronic infection. Conclusions The high prevalence of exposure and infection with HCV in pregnant women involved in pharmacotherapy for a substance use disorder indicate a need for ongoing surveillance and testing for HCV. Identifying HCV during pregnancy is crucial because this identification would serve to enhance medical care and potentially prevent vertical transmission. Identifying HCV would also facilitate referrals to newly available curative HCV treatments following delivery.

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Acknowledgements

We would like to acknowledge Sonnie Williams, B.S.; Laura Garrison, M.A.; and Hilda Gutierrez, B.S.; Shikhar Shrestha, M.S. for recruitment of study subjects, data collection, and assistance with the data management and analyses, and William Rayburn, M.D., M.B.A. for his contribution to the study design of BIPS and ENRICH cohorts. We also acknowledge Dr. Karla Thornton for sharing expertise on HCV treatment and reviewing the manuscript. Finally, we are in debt to the Milagro clinic providers and patients who contribute their time and knowledge to this BIPS and ENRICH cohorts.

Funding

This work has been supported by research grants from NIAAA/NIH (1R01AA021771, 1R03AA020170) and NCRR/NIH (8UL1TR000041). KP received funding from the UNM CTSC (UL1TR001449).

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Correspondence to Kimberly Page.

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Page, K., Leeman, L., Bishop, S. et al. Hepatitis C Cascade of Care Among Pregnant Women on Opioid Agonist Pharmacotherapy Attending a Comprehensive Prenatal Program. Matern Child Health J 21, 1778–1783 (2017). https://doi.org/10.1007/s10995-017-2316-x

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Keywords

  • Pregnancy
  • Opioid-use disorder
  • Opioid agonist pharmacotherapy
  • Hepatitis C virus
  • Prenatal care