The Philadelphia Department of Health (PDPH) established that ~1% of births in Philadelphia are to Hepatitis C virus (HCV)-positive women, and it is known that 5-10% of perinatally exposed infants will develop chronic disease. PDPH found that of 605 infants born to HCV-positive women during 2011-2013, 80% were not appropriately tested for HCV infection; 8% were tested after 18 months of age. To address this gap, PDPH launched a pilot project to improve testing rates among infants born to HCV-positive women.
METHODS:
HCV RNA-positive mothers who gave birth in Philadelphia in 2012-2013 were identified by matching the PDPH hepatitis registry to electronic birth record data. HCV-exposed children were matched back to the hepatitis registry to assess test history. Mothers of children 18 – 24 months with no HCV testing record were contacted by phone, asked questions relating to perinatal HCV, and sent a formal letter outlining the HCV tests their child needed. Mothers were also asked permission for PDPH to alert their pediatrician of child’s need for HCV testing. 3-6 months after the intervention, each child’s HCV testing status was reassessed.
RESULTS:
Matches yielded 90 mother-child pairs, of whom 51 mothers (59%) were successfully contacted, 6 (10%) were no longer the child’s guardian, and 30 (33%) were unable to be located. Three children were in the care of Child Welfare services. Contacted mothers were more likely to be ≥30 years old and have an education beyond high school (p<0.001). Seventeen (32%) of the women were receiving HCV care and most (87%) understood the risk of perinatal transmission. Thirty-three (62%) of women claimed that their child’s pediatrician knew her HCV status, 58% (n=19) of whom mother had informed themselves. After outreach, 16 (30%) children were tested for HCV, all of whom were HCV-antibody negative.
CONCLUSIONS:
This project represents the first attempt to actively identify and promote testing for children born to HCV-positive women by a US health department. Though testing improved, the low HCV testing rates following the intervention suggest a need to increase provider awareness of perinatal HCV risk and appropriate testing regimens. In addition, child services organizations may need to be educated concerning perinatal HCV risk among their clients. Findings also illustrate a wide gap in knowledge amongst HCV-positive women. Lastly, the large number of mothers unable-to-locate demonstrates the high mobility rate in Philadelphia, especially among populations at-risk for HCV, and a need for earlier intervention.