Selected and summarized by Ronald O. Valdiserri, MD, MPH, Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, and Co-Chair of HepVu.
Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights “Racial and Ethnic Disparities in Hepatitis C Care in Reproductive-Aged Women with Opioid Use Disorders.” Biondi BE, Munroe S, Lavarin C, Curtis MR, Buzzee B, Lodi S, Epstein RL. Clinical Infectious Diseases 2024, December 15; 79(6): 1428-1436. PMID 39356149
What question(s) does this study address?
It is well established that rates of infection with hepatitis C virus (HCV) increased in the United States, concurrent with the opioid use epidemic and its associated injection drug use. Since the onset of the opioid use epidemic in the US, the prevalence of HCV infection during pregnancy has increased markedly, from 0.34 cases per 1000 pregnancies in 1998 to 5.3 cases per 1000 pregnancies in 2018—increasing the risk of adverse health outcomes for both women and their newborn infants. Mother to child transmission of HCV during pregnancy occurs in approximately 7% of children born to women with untreated HCV infection; the rate of vertical transmission is even higher, i.e., 12%, if the mother is also co-infected with human immunodeficiency virus.
Timely diagnosis of HCV infection and initiation of curative treatment can lead to HCV elimination and current screening guidelines recommend universal one-time screening for all adults and periodic repeat testing for those with ongoing risk factors like injection drug use; women should be screened for HCV during each pregnancy. Yet, despite these guidelines and the availability of curative treatment, the Centers for Disease Control and Prevention (CDC) reported 93,805 new cases of chronic hepatitis infection during 2022 and 35% of these cases were among women.
Despite the well-known association between opioid use disorders (OUD) and the increased risk for blood-borne viral infections like HCV, many persons with the diagnosis of OUD are not tested for HCV. Using data from the TriNetX Research Network, Biondi and her colleagues sought to examine racial and ethnic disparities in HCV testing and care among a large national US cohort of reproductive-aged women with a diagnosis of OUD.
What are the major findings of this report/article?
- The study population consisted of 104,625 women of reproductive age (i.e., 15-44 years) with a diagnosis of OUD who visited any one of 55 participating health care organizations across all 4 US regions from January 2014 to November 2022.
- 8% of the women were white, 9.5% were black/African American, 0.9% were American Indian/Alaska Native (AI/AN), 0.3% were Asian, and 11.5% were of unknow race. 5.7% reported Hispanic/Latinx ethnicity. The average age was 30.9 years.
- Overall, 44.6% of women had an HCV antibody test and 22.9% (n = 23,951) were seropositive. Among the HCV seropositive women, 92.7% had an HCV RNA test, and 16.2% of those (n = 16,968) were positive.
- Among the HCV RNA (+) women, 55.2% were linked to care and only 9.1% (n = 1545) had evidence of receiving a prescription for curative antiviral therapy.
- AI/AN women had a 28% higher probability of HCV antibody testing compared to white women.
- Compared to white women, Asian and black/African American women had a lower probability of having an HCV antibody test.
- Except for Asians, women of all races and ethnicities had a higher predicted probability of HCV antibody testing if they were also infected with HIV.
- There were no significant differences in linkage to care (LTC) by race or ethnicity.
- Among women with LTC, Hispanic/Latinx individuals had a 63% higher probability of initiating HCV treatment compared to non-Hispanic/Latinx persons.
What are the implications for the prevention and control of viral hepatitis?
- Although HCV antibody testing increased over time in this study, by its end (i.e., November 2022), less than half (44.6%) of this high risk cohort of women had been tested for HCV and barely one out of ten (9.1%) women with diagnosed HCV infection had been treated with direct-acting antivirals.
- Innovative models of care are needed to diagnose and treat HCV infection among women with OUD in order to prevent adverse health outcomes among these women and to eliminate the risk of vertical HCV transmission from infected mothers to their infants.
- Persistent racial/ethnic disparities in HCV testing among this cohort of high risk women underscores the need to develop policy interventions and models of care that address the unique needs of specific minority groups, including women of various race/ethnicities who are grappling with opioid use disorders.
