Author: Epstein RL, Moloney C, Pelton SI

Theme: Models of Care Year: 2019

Background: The current opioid epidemic is associated with rising hepatitis C virus (HCV) incidence,
primarily in young adults, including women of reproductive age. Prenatal care, as a major source of
healthcare for young women, may provide a unique opportunity to integrate substance use care and
HCV linkage and treatment.
Description of model of care/intervention: In an urban safety-net hospital, pediatric infectious diseases
initiated in 10/2016 consultations at delivery for all pregnant women identified as HCV antibody
positive, to facilitate linkage to maternal HCV treatment and infant pediatric follow-up. Consultations
involve nurse practitioner inpatient visits, appointment coordination, and contact during outpatient
primary and specialty care visits. To evaluate intervention impact, we analyzed electronic health record
data to characterize HCV linkage through 5/2018 for women delivering from 1/2014-3/2018.
Effectiveness: From 1/2014-9/2016, 230 anti-HCV positive women delivered at our institution. Of those,
217 (94.3%) had HCV nucleic acid (RNA) testing. Of 170 (78.3%) with positive RNA testing, 125 (73.5%)
had genotype testing, and 28 (16.5%) had HCV treatment prescribed by 5/2018. From 10/2016-3/2018,
121 anti-HCV positive women delivered; 100% were HCV RNA-tested during pregnancy. Of 81 HCV RNA
positive women, 66 (81.5%) had genotype testing, and 20 (24.7%) had evidence of successful linkage via
HCV treatment prescribed by study end. Of anti-HCV positive women, 96% had diagnosed concurrent or
previous substance use. Primary care physicians involved in outpatient addiction treatment comprised
50% of HCV prescribers pre-intervention and 55% post-intervention.
Conclusion and next steps: HCV treatment initiation rates in women with chronic HCV and substance
use improved in the setting of a pediatric infectious diseases linkage intervention and institution and
statewide initiatives to increase access to HCV treatment. This study demonstrates a novel linkage to
cure model integrating perinatal care, substance use treatment, HCV treatment, and infant HCV
screening together to improve joint outcomes.
Disclosure of Interest Statement: The authors have no relevant conflicts of interest to disclose

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