Innovative approach helps new mothers get hep C treatment

Giving postpartum mothers with hepatitis C the opportunity to start antiviral treatment while they are still in the hospital after giving birth, significantly increases their odds of completing the therapy and being cured.

The authors of a recent study found that new mothers who saw an infectious disease specialist and received medication for hepatitis C during their hospital stay were twice as likely to be cured compared with mothers who got a referral to an outpatient follow-up appointment.

Laura Marks, MD, PhD is senior author on the study and an assistant professor in the Division of Infectious Diseases in the John T. Milliken Department of Medicine at Washington State University School of Medicine.

She said: “We were seeing too many patients fall through the cracks simply because of traditional divisions between what was treated inpatient labour and delivery versus outpatient – hepatitis C.

“We partnered across departments to make sure that when pregnant patients come to Barnes-Jewish Hospital to deliver their babies, they have the option to also get care for a disease that, if left untreated, can lead to cancer.”

Patients are often diagnosed with hepatitis C as part of routine screenings during pregnancy, but treatment has historically been deferred to the postpartum period.

However, once women give birth, they don’t always return for follow-up care to start the medication.

To break the cycle, researchers implemented a “Meds to Beds” approach:

Instead of referring patients with hepatitis C to outpatient follow-up care after discharge, the obstetrics and maternal-foetal medicine care team would begin the process required for an infectious disease specialist to initiate treatment before the patient was discharged.

To evaluate the effectiveness of this collaborative approach, Marks and first author Madeline McCrary, MD reviewed medical records of 149 mothers who delivered babies at Barnes-Jewish Hospital between January 2020 and September 2023 and had tested positive for hepatitis C.

Depending on the timing and availability of infectious disease specialists, the women either received immediate hepatitis C treatment while still in the hospital after giving birth or got a referral for an appointment at an outpatient infectious disease clinic or hepatology clinic after their discharge.

Overall, two-thirds of the patients who began treatment in the hospital successfully completed the full course of treatment — two to three months of antiviral medication — compared with about one-third of the outpatient referral group.

The researchers found that over half of postpartum mothers in the outpatient referral group did not attend the follow-up appointment.

The researchers measured successful treatment completion with a lab test confirming that the patient was no longer positive for hepatitis C or with a patient’s report that they had taken the full course of antiviral medication.

Kelly said: “Curing hepatitis C in these mothers has a huge ripple effect — it protects their health, their families and their future pregnancies.

“That’s why we partnered with our infectious disease colleagues to rethink how we could close the gaps in treatment.

“This new study shows that simply bringing the medication to the patient’s bedside right after delivery dramatically reduces the number of patients lost along the way.”

WashU Medicine’s division of infectious diseases and division of maternal-foetal medicine have also partnered to integrate infectious diseases care into obstetrics clinics, including implementing new guidelines endorsing shared decision-making around treating hepatitis C during pregnancy.