Cascade of Care
Routinely providing hepatitis C screening to pregnant women who are undergoing treatment for opioid use disorder can help steer them to effective treatments to eradicate the infection, University of New Mexico researchers have found.
In a new study published in the journal Maternal and Child Health (and highlighted in the director’s report of the National Institute on Drug Abuse), the researchers found that a high percentage of women with opioid addictions enrolled in UNM’s Milagro Program, which provides prenatal care for women with substance abuse disorders, tested positive for hepatitis C virus (HCV).
The virus is transmitted in blood, typically through intravenous drug use. It causes damage slowly and with few outward symptoms over a period of decades, but over the long term the infection can result in liver cancer.
“The opioid epidemic in the United States is now associated with a 300 percent increase in hepatitis C in people ages 18-39 between 2004 and 2015,” said Kimberly Page, MD, a professor in UNM’s Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, who was a study co-author.
“We’re seeing increases in particular among younger people,” she said. “We wanted to find out what was the prevalence of hepatitis C and the diagnostic cascade of care.”
Cascade of care in this case refers to sequential tests conducted to see whether a patient has been exposed to hepatitis C, and if so, whether she has an active hepatitis C infection. Further testing can reveal the specific subtype of the virus.
The data for the study came from long-term research conducted with Milagro Program patients, said senior author Ludmila Bakhireva, MD, PhD, associate professor and Regents’ Lecturer for the Department of Pharmacy Practice and Administrative Sciences in the UNM College of Pharmacy.
The Biomarkers in Pregnancy Study, launched in 2009, and the Ethanol Neurodevelopment Infant and Child Health study (started in 2012), collected extensive medical information from women who chose to participate, Bakhireva said.
To gauge hepatitis C exposure, Bakhireva, Page and their colleagues reviewed the records of 190 women. Virtually all were undergoing treatment for opioid use with buprenorphine (commercially known as Suboxone) or methadone.
Ninety-four percent of the women had been tested for hepatitis C antibodies, showing whether they had ever been exposed to the virus. Of that group, 53 percent tested positive. Ninety-percent of those who tested positive were tested for hepatitis C RNA, which diagnoses a chronic infection. Of that number, 76 percent tested positive.
In all, nearly 40 percent of the women had chronic hepatitis C infection, the researchers found.
“These results inform the larger public health community about the burden of HCV infection, and provide opportunities to optimize screening and diagnosis of HCV in prenatal settings,” the authors wrote.
Page said only 5 percent of babies born to mothers with active hepatitis C infections contract the virus. New drug therapies proven to eliminate the infection are available for both mothers and children, she added. “There are no barriers for this population to get hepatitis C treatment in New Mexico.”
As a result of this research, study co-author Lawrence Leeman, MD, professor in UNM’s Department of Family & Community Medicine, and medical director of the Milagro clinic, has made policy changes to institute a more rigorous follow-up system for women who test positive for the virus, Bakhireva said.
“This highlights the uniqueness of the Milagro program,” she said. “It is really integrated within a family practice model. It eliminates barriers and reduces stigmatization for this vulnerable population.”