Author information
1Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA. Electronic address: ngupta-consultant@taskforce.org.
2Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA.
3Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA.
4Pediatric Department, Ain Shams University, Cairo, Egypt; Clinical Research Center, Faculty of Medicine, Ain Shams University (MASRI-CRC), Cairo, Egypt.
5Department of Medicine, Aga Khan University, Karachi, Pakistan.
6Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; AASLD/IDSA HCV Guidelines Panel and AASLD Viral Hepatitis Elimination Task Force, Alexandria, VA, USA.
7MRC Clinical Trials Unit, University College London, United Kingdom; Fondazione Penta ETS, Padova, Italy.
8Division of Liver Diseases, Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA; AASLD/IDSA HCV Guidance Panel and Chair AASLD Women's Initiatives Committee, Alexandria, VA, USA.
9Division of Maternal Fetal Medicine, Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA.
10School of Nursing, Faculty of Health, York University, Toronto, Canada; Viral Hepatitis Care Network at the Canadian Network on Hepatitis C, Toronto, Canada.
11Division of Addiction Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
12System Chief of Obstetrics, OhioHealth, Columbus, OH.
13Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA; AASLD/IDSA HCV Guidance Panel, AASLD Hepatitis C Special Interest Group, Alexandria, VA, USA.
Abstract
There is an increasing burden of hepatitis C virus among persons of reproductive age, including pregnant and breastfeeding women, in many regions worldwide. Routine health services during pregnancy present a critical window of opportunity to diagnose and link women with hepatitis C virus infection for care and treatment to decrease hepatitis C virus-related morbidity and early mortality. Effective treatment of hepatitis C virus infection in women diagnosed during pregnancy also prevents hepatitis C virus-related adverse events in pregnancy and hepatitis C virus vertical transmission in future pregnancies. However, linkage to care and treatment for women diagnosed in pregnancy remains insufficient. Currently, there are no best practice recommendations from professional societies to ensure appropriate peripartum linkage to hepatitis C virus care and treatment. We convened a virtual Community of Practice to understand key challenges to the hepatitis C virus care cascade for women diagnosed with hepatitis C virus in pregnancy, highlight published models of integrated hepatitis C virus services for pregnant and postpartum women, and preview upcoming research and programmatic initiatives to improve linkage to hepatitis C virus care for this population. Four-hundred seventy-three participants from 43 countries participated in the Community of Practice, including a diverse range of practitioners from public health, primary care, and clinical specialties. The Community of Practice included panel sessions with representatives from major professional societies in obstetrics/gynecology, maternal fetal medicine, addiction medicine, hepatology, and infectious diseases. From this Community of Practice, we provide a series of best practices to improve linkage to hepatitis C virus treatment for pregnant and postpartum women, including specific interventions to enhance colocation of services, treatment by nonspecialist providers, active engagement and patient navigation, and decreasing time to hepatitis C virus treatment initiation. The Community of Practice aims to further support antenatal providers in improving linkage to care by producing and disseminating detailed operational guidance and recommendations and supporting operational research on models for linkage and treatment. Additionally, the Community of Practice may be leveraged to build training materials and toolkits for antenatal providers, convene experts to formalize operational recommendations, and conduct surveys to understand needs of antenatal providers. Such actions are required to ensure equitable access to hepatitis C virus treatment for women diagnosed with hepatitis C virus in pregnancy and urgently needed to achieve the ambitious targets for hepatitis C virus elimination by 2030.