Hepatitis C Is Widespread but Rarely Treated in Postpartum Medicaid Beneficiaries With OUD

Getting an appointment with an infectious diseases specialist, particularly after giving birth and while managing a chronic disorder, such as substance use, is difficult, investigators say.

Nearly one-third of pregnant Medicaid beneficiaries who have opioid use disorder (OUD) and are screened for hepatitis C test positive for the virus, according to results of a study led by investigators from the University of Pittsburgh School of Public Health.

Despite the availability of a pill that cures the disease, fewer than one-fifth of these women receive follow-up care for their hepatitis C diagnosis within 6 months of giving birth, according to the results of the study, which was published in Obstetrics & Gynecology.

“When we first saw these results, we thought, ‘This is far too low of a treatment rate, and there must be an error in our analysis,’” Marian Jarlenski, PhD, MPH, associate professor of health policy and management at Pitt Public Health, said in a statement. “Navigating the medical system to get an appointment with an infectious diseases specialist, particularly after giving birth and while managing a chronic disorder, such as substance use, can be incredibly difficult.”.

Hepatitis C is passed from mother to baby in about 6% of pregnancies, and the CDC has recommended that women with substance use disorder be screened for hepatitis C while pregnant.

In 2020, with the development of effective oral medication that can cure hepatitis C, the CDC expanded the screening recommendation to include all pregnant women.

The Medicaid Outcomes Distributed Research Network, led by Julie Donohue, PhD, professor and chair of health policy and management at Pitt Public Health and co-author of the study, obtained deidentified, standardized data from 6 states included in this study: Delaware, Kentucky, Maine, North Carolina, Pennsylvania, and West Virginia.

Data from 23,780 Medicaid recipients who had received a diagnosis of OUD and had a live or still birth between 2016 and 2019 were analyzed for the study.

Investigators found that about 70% of women in the study were tested for hepatitis C, and 31% of those had a positive diagnosis. At 2 months’ postpartum, just 3.2% of the women with a positive diagnosis had received any follow-up visits or medication to treat the virus, and at 6 months that rate rose to 5.9%.

“As our research shows, telling a new parent they have hepatitis C and need to make an appointment with an infectious diseases specialist simply isn’t translating into treatment,” Jarlenski said. “With universal hepatitis C screening during pregnancy, the existence of a pill that cures this devastating illness and expanded postpartum Medicaid coverage to pay for that treatment, finding a sustainable pathway to care is critical.”

A better way to ensure that women who are positive for hepatitis C receive treatment is to get them that treatment while they are still pregnant and engaged in care, Jarlenski said.

The results of a small phase 1 clinical trial published in The Lancet Microbe showed that all 9 women who were positive for hepatitis C and took the medication while in their second trimesters were cured and gave birth to healthy and hepatitis-free babies.

Further investigation is needed, and larger trials are ongoing, according to investigators.

Reference

Hepatitis C widespread but rarely treated in postpartum Medicaid beneficiaries with opioid use disorder. EurekAlert. News release. April 7, 2022. Accessed April 8, 2022. https://www.eurekalert.org/news-releases/948685