Prenatal Hepatitis C Screening in Kentucky: Does a Change in the Law Change Clinical Practice? [14A

Abstract

INTRODUCTION: Prevalence of hepatitis C virus (HCV) infection among pregnant women is highest in Kentucky. ACOG endorses a risk-based approach for prenatal HCV screening; however gaps in identification can occur. In 2018, Kentucky became the first state nationwide to legislatively mandate universal HCV screening for all pregnant women. METHODS: This retrospective study evaluates trends of prenatal HCV testing before and after a universal HCV screening requirement. Women with an ICD-9/ICD-10 code indicating delivery at UK Healthcare (UKHC) in 2016 through 2018 were identified; those with laboratory results for HBsAg in the 10 months prior to delivery were considered to have had prenatal care within UKHC and included in the study cohort. Electronic medical records were reviewed to identify maternal characteristics and anti-HCV test results. RESULTS: Among 5,616 women with deliveries, 3,869 (69%) had documentation of prenatal HBsAg testing and included in the study cohort. Of these, 48 (1.2%) had a diagnosis of HCV infection and an additional 716 (19%) had prenatal anti-HCV testing. Among women screened for HCV, 179 (25%) were anti-HCV positive. A total of 363 women in the cohort had a diagnosis indicating illicit drug use; 53 (15%) were neither tested for HCV nor had an existing HCV diagnosis. Prevalence of prenatal HCV screening increased significantly from 18% at baseline to 31% among women who delivered after the universal screening legislation became effective (P<.0001). CONCLUSION: A significant increase in HCV testing was observed following the universal HCV screening legislation, however testing uptake remained low. Efforts to improve implementation are warranted.