Integrating Hepatitis C Treatment in the Postpartum Setting: A Call for Practice Innovation

Hepatitis C virus (HCV) affects an estimated 50 million people worldwide. Prevalence among persons who are pregnant has increased 161% between 2009 and 2017, largely driven by increasing maternal injection drug use. Although the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention now recommend universal prenatal HCV screening, diagnosis during pregnancy too often does not result in timely treatment postpartum. Consistent with research at other institutions, internal review at our medical center revealed that referrals to gastroenterology or infectious disease specialists resulted in low follow-through, with few patients receiving curative therapy. To address this gap, we implemented a patient-centered program integrating HCV care into the outpatient prenatal and postpartum service at our rural academic medical center. This article describes a practice innovation which streamlines the process from confirmatory testing during pregnancy to the initiation and follow-up for direct-acting antiviral treatment postpartum. Embedding postpartum HCV treatment within routine perinatal services reduces barriers to cure and is well within the scope of midwifery and other obstetric practice. Adoption of this patient-centered approach accelerates progress toward regional and global HCV elimination goals.