US study shows gaps in hepatitis C testing, care for women at risk
Fewer than half of reproductive-aged women with opioid use screened
Fewer than half of reproductive-aged women with opioid use disorder in the U.S. undergo hepatitis C testing, with Black and Asian women less likely than their white counterparts to be screened for the viral infection, according to a new study.
Among women in the study who did test positive for hepatitis C, fewer than 1 in 10 were ultimately treated with antiviral medications, the researchers found.
“We need to determine what disparities occur in hepatitis C screening and treatment and learn how to overcome them to ensure that all people have equitable access to care,” Rachel Epstein, MD, the study’s senior author and an infectious disease clinician-scientist at Boston Medical Center (BMC), said in a BMC press release.
Because the hepatitis C virus, or HCV, can be passed on from mother to child during pregnancy and childbirth, addressing barriers to testing and treatment among reproductive-aged women at risk of hepatitis C — including those with opioid use disorders — is critical for not only their own health but also the health of their children, the study noted.
“By prioritizing equity in our healthcare approaches, we can ensure that parents and their children have the opportunity for timely diagnosis and effective treatment,” said Epstein, also an assistant professor of medicine and pediatrics at Boston University. “Effective screening and treatment for hepatitis C virus in reproductive-aged women is a powerful tool for breaking the cycle of transmission.”
The study, “Racial and Ethnic Disparities in Hepatitis C Care in Reproductive-Aged Women With Opioid Use Disorder,” was published in the journal Clinical Infectious Diseases.
Hepatitis C testing key to help ID women of childbearing age at risk
Hepatitis C is a type of hepatitis, or liver inflammation, caused by HCV, a virus spread through exposure to blood or other bodily fluids from an infected person. The most common mode of transmission is through the sharing of contaminated needles or other equipment used to inject recreational drugs.
The virus can also be transmitted from mother to child during pregnancy or childbirth, and this perinatal transmission is the cause of most hepatitis C cases in children.
Over the long term, chronic, unresolved hepatitis C can drive serious liver damage. However, treatment is now available with antiviral medications that are able to resolve the infection in the vast majority of patients.
Nonetheless, a number of studies have found disparities in hepatitis C care, with individuals in racial and ethnic minority groups less likely to be tested and treated.
If we aren’t testing people, we can’t connect them to care and that can lead to significant complications, including transmitting the virus. … Treating women postpartum or during pregnancy for hepatitis C infections … is important to improving health outcomes for everyone.
And, while hepatitis C diagnoses among women of reproductive age in the U.S. are on the rise in the context of the opioid epidemic, little is known about racial and ethnic disparities in hepatitis C testing and treatment in reproductive-aged women with opioid use disorder.
“If we aren’t testing people, we can’t connect them to care and that can lead to significant complications, including transmitting the virus,” said Breanne Biondi, the study’s first author and a PhD candidate at Boston University School of Public Health.
According to Biondi, “Treating women postpartum or during pregnancy for hepatitis C infections … is important to improving health outcomes for everyone.”
To fill this knowledge gap, the research team analyzed electronic health records from 2014 to 2022. The records covered 104,635 reproductive-aged women in the U.S., ages 15-44, who were diagnosed with opioid use disorder.
Black, Asian women less likely to be screened than white counterparts
The results showed that fewer than half of the women (44.6%) were tested for antibodies against HCV — a way of evaluating if a person has ever been infected with the virus.
Asian and Black women were more than 20% less likely to have an HCV antibody test than white women. Conversely, those identifying as American Indian or Alaska Native were 28% more likely to get screened than white women.
Further, fewer than 10% of women with a confirmed HCV infection received antiviral therapy to treat it. Hispanic and Latina women were found to be more likely to receive treatment — by 63% — than non-Hispanic/Latina women.
These findings highlight that “few reproductive-aged women with [opioid use disorder] are tested or treated for HCV,” the researchers wrote, adding that “disparities by race and ethnicity in HCV testing further exacerbate the risk of perinatal transmission and disease progression among minoritized communities.”
According to the team, “interventions are needed to improve overall rates of and equity in HCV screening and treatment for reproductive-aged women.”
Ongoing projects at BMC are aimed at achieving that, the researchers noted. Among them are Project RESPECT, a pilot program in which doctors and pharmacists work together to make hepatitis C treatment a part of routine postpartum care for women with substance use disorders as a way of preventing transmission in future pregnancies.
Doctors at BMC also have launched an initiative to ensure that hepatitis C is discussed with all birthing parents during their delivery and hospital stay. Since the program was adopted, women treated at BMC have started hepatitis C treatment at more than twice the rate before.
“By identifying and treating hepatitis C early, we can significantly reduce the risk of severe disease and prevent transmission to children, ultimately improving both maternal and infant health outcomes,” Epstein said.
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