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Principal Investigator: Shashi Kapadia
Organization: WEILL MEDICAL COLL OF CORNELL UNIV
Fiscal Year: 2024
Award: $707,647
Funding agency: National Institute on Drug Abuse
PROJECT ABSTRACT:
Hepatitis C virus (HCV) during pregnancy predominantly affects people who inject drugs. The rates of perinatal
HCV and maternal to child transmission are rising in concert with the current injection drug use crisis. Testing
for HCV in the perinatal period has been inadequate, as has testing of infants born to mothers infected with
HCV. To improve testing rates, several professional societies released guidance recommend universal HCV
testing with each pregnancy in spring of 2020. However, screening recommendations are not universally
followed, and may not be applied equitably across populations. Additionally, we do not know whether an
increase in testing ultimately leads to the desired downstream outcomes of linkage to care, treatment, and
identification of infants at risk for perinatal transmission. In this proposal, we will use national Medicaid and
commercial claims data to examine HCV testing and treatment among pregnant and postpartum women and
their infants. Specifically, we will 1) determine whether the testing guideline change was associated with
increased HCV testing rates among pregnant women compared to non-pregnant reproductive age women; 2)
determine whether the guideline change was associated with increased postpartum HCV linkage to care and
treatment as well as other aspects of maternal care, and 3) determine whether the guidelines were associated
with increases in appropriate HCV testing and diagnoses for infants born to HCV-infected mothers in Medicaid.
In each aim, we will examine variation in the implementation of HCV testing, identifying targets for further
public health and policy intervention. Understanding the landscape of HCV testing for the perinatal population
is critical for eliminating HCV and improving the lifetime health of people who use drugs.
Terms: <0-11 years old><ACOG><AIDS Virus><Abdominal Delivery><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Affect><Age><American College of Obstetricians and Gynecologists><Bile Duct Obstruction><Biliary Stasis><Birth><C section><Caring><Cesarean><Cesarean section><Characteristics><Child><Child Youth><Children (0-21)><Cholestasis><Clinical><Complex><Data><Development><Diagnosis><Disease><Disorder><Disparities><Disparity><Drug usage><Drug user><Drugs><Enrollment><Equity><Ethnic Origin><Ethnicity><Evaluation><Failure><Gestation><Gestational Hypertension><Guidelines><HCV><HCV infection><HCV screening><HCV therapy><HCV treatment><HIV><Health><Hepatitis C><Hepatitis C Therapeutics><Hepatitis C Therapy><Hepatitis C Virus Treatment><Hepatitis C treatment><Hepatitis C virus><Hepatitis C virus infection><Hepatitis C virus screening><Hepatitis, Viral, Non-A, Non-B, Parenterally-Transmitted><Hepatitus C><Heterogeneity><High Risk Woman><Human Immunodeficiency Viruses><Hypertension induced by pregnancy><Hypertension-Associated Pregnancy Disorder><Infant><Injecting drug user><Injection Drug User><Interruption><Intervention><Intervention Strategies><LAV-HTLV-III><Laboratories><Link><Live Birth><Low Birth Weight Infant><Lymphadenopathy-Associated Virus><Measures><Mediating><Medicaid><Medication><Methods><Modification><Mothers><Outcome><PWID><PWUD><Parturition><Patients><Perinatal><Perinatal transmission><Peripartum><Pharmaceutical Preparations><Policies><Population><Position><Positioning Attribute><Post-partum Women><Postpartum Period><Postpartum Women><Pregnancy><Pregnancy Associated Hypertension><Pregnancy Outcome><Pregnant Women><Premature Birth><Prematurely delivering><Prenatal care><Preterm Birth><Process><Professional Organizations><Public Health><Public Policy><Race><Races><Recommendation><Records><Risk><Risk Factors><Sampling><Series><Substance Use Disorder><Testing><Time><Transmission><Treatment outcome><Update><Urbanicity><Variant><Variation><Vertical Transmission><Virus-HIV><Woman><aged><ages><at-risk females><at-risk women><bile obstruction><bile occlusion><cholestatic diseases><cholestatic disorder><cholestatic liver disease><cholestatic liver disorder><cholestatic syndromes><design><designing><developmental><drug use><drug/agent><econometrics><enroll><expectant mother><expecting mother><experience><females at high risk><hep C><hepatitis non A non B><high risk females><hypertensive disease of pregnancy><improved><infection by hepatitis c virus><injection drug use><intervention delivery><interventional strategy><kids><low birth weight><low birthweight><maternal outcome><mother outcome><non A, non B hepatitis><non-A, non-B hepatitis><novel><opiate use disorder><opioid use disorder><people who inject drugs><people who inject illicit drugs><people who use drugs><people who use illicit drugs><perinatal outcomes><perinatal period><perinatal phase><persons who inject drugs><persons who use drugs><post-partum><pregnancy care><pregnancy hypertension><pregnant><pregnant mothers><premature childbirth><premature delivery><prenatal><prenatal appointment><prenatal checkup><prenatal screening><prenatal testing><prenatal visit><preterm delivery><professional association><professional membership><professional society><programs><racial><racial background><racial origin><recommended screening><reproductive><screening><screening guidelines><screening recommendations><screenings><service delivery><substance use and disorder><testing uptake><transmission process><trend><unborn><uptake><viral testing><virus testing><women at high risk><youngster>