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Micro‐elimination of hepatitis C through testing of Egyptian pregnant women presenting at delivery: implications for screening policies
Author(s) -
Mostafa Aya,
Ebeid Fatma S.E.,
Khaled Belal,
Ahmed Rania H.M.,
ElSayed Manal H.
Publication year - 2020
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13404
Subject(s) - medicine , breastfeeding , hepatitis c virus , obstetrics , hepatitis c , pregnancy , medical record , adverse effect , abortion , pediatrics , immunology , virus , biology , genetics
Objectives Despite the high burden of hepatitis C virus (HCV) infection in Egypt, screening of pregnant women is not yet universal, making national and global elimination unlikely. This study assessed the proportion of pregnant women who were screened for HCV infection at delivery, the prevalence and risk factors for HCV infection, the associated adverse neonatal outcomes, and the real‐life linkage to care of infected women and follow‐up of their infants’ HCV status and timing of testing. Methods Data were collected from medical records of a retrospective cohort of all pregnant women who were admitted to a university hospital in Cairo for delivery between January and June 2018 ( n = 6734). HCV antibody‐ and RNA‐positive women and their infants were prospectively followed‐up by phone interviews till September 2019. Results 2177 (32.3%) pregnant women were screened for HCV infection. 19 (0.9%) tested HCV antibody‐ and RNA‐positive. Being ≥ 30 years old (ORa 3.6, 95% CI: 1.4–9.2; P = 0.009), history of abortion (ORa 3.5, 95% CI: 1.2–10.3; P = 0.022) and blood transfusion (ORa 29.1, 95% CI: 9.6–88.4; P < 0.001) were independent risk factors for infection. Adverse neonatal outcomes did not vary significantly among HCV antibody‐positive and antibody‐negative women. Only 13 (68.4%) HCV antibody‐ and RNA‐positive women started treatment with direct‐acting antivirals (DAAs) post‐breastfeeding (two completed the treatment course and were cured). Four (21.1%) did not start treatment, and two (10.5%) were lost to follow‐up. All infants of the 13 HCV antibody‐ and RNA‐positive women who started DAA therapy tested HCV RNA‐negative within their first year of life. Conclusion Extending screening services to all pregnant women and better linkage to care are essential for the national elimination of HCV infection.