Antenatal screening for hepatitis C: Universal or risk factor based?

There is no clear consensus on whether antenatal screening for hepatitis C (HCV) should be universal, or based on an assessment of risk factors.

To report the HCV status and risk factors for HCV amongst women delivering at a tertiary metropolitan hospital in order to better understand the implications of changing from universal to risk factor based HCV screening.

An audit of practice was performed at Mater Mothers' Hospitals (Brisbane) using routinely collected data from 2007 to 2013 (n = 57,659). The demographic and clinical characteristics of HCV-positive women (n = 281) were compared with those with a negative result (n = 57,378), and compared for the presence or absence of risk factors for HCV.

From a cohort of 57,659 women, 281 (0.5%) women were HCV positive. HCV-positive women were more likely to have received blood products (10.0 vs 3.1%; P < 0.001), have a history of illicit drug use (72.2 vs 9.8%; P < 0.001), and have at least one risk factor for HCV infection (92 vs 17%; P < 0.001). Of the HCV-positive women, only seven of the 281 (2.5%) had no identifiable risk factor, whilst most (83%) HCV-negative women did not have any documented risk factor for HCV infection.

Most women testing positive for HCV antibodies have identifiable risk factors; however, a small number will not be detected if a risk factor based screening approach is adopted. The benefits of universal screening must be weighed against the potential cost savings of a risk factor based screening program.