Association of Postpartum Inpatient Consultation Compared With Outpatient Referral With Hepatitis C Virus Treatment...

To evaluate the associations of a traditional postpartum outpatient referral compared with an opportunistic inpatient consultation for hepatitis C virus (HCV) treatment initiation on HCV treatment completion.

We performed a retrospective evaluation of the HCV perinatal care cascade for women who delivered at Barnes-Jewish Hospital between January 1, 2020, and September 1, 2023. We compared an intervention that provided immediate HCV treatment on discharge after delivery with referral to postpartum outpatient HCV care. Obstetric patients were allocated to either inpatient treatment or outpatient follow-up based on the availability of inpatient consultants. The primary outcome was treatment completion, defined as patient-reported completion of direct-acting antivirals (DAAs) or sustained virologic response or negative HCV viral load at 4 weeks or more. The association of the two treatment strategies with treatment completion was assessed using logistic regression.

A total of 149 HCV-affected pregnancies were reviewed. One hundred twenty-five (83.9%) women were referred to HCV treatment during their pregnancies or during their delivery admissions, with 33 (26.4%) in the inpatient referral group and 92 (73.6%) in the outpatient referral group. All individuals in the inpatient referral group had an inpatient consultation; however, a majority of those (55.4%) in the outpatient referral group (92/125; 73.6%) did not present for consultations. Among women who were prescribed DAAs, inpatient referral was associated with higher rates of HCV treatment completion (20/30; 66.7%) compared with standard care (14/41; 34.0%). Inpatient treatment was associated with 4.7 times higher adjusted odds of treatment completion (95% CI, 1.57-14.00).

Providing immediate bedside delivery of DAAs at discharge from labor and delivery for women with HCV-affected pregnancies was associated with higher rates of treatment completion than referral for outpatient follow-up. The model of care should be considered for broader implementation.