Author information

¹Department of Medicine, Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.

²Department of Pediatrics, Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.

³Boston University School of Public Health, Boston, MA, USA.

⁴Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA.

⁵Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.

⁶Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

⁷Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.

⁸Department of Pediatrics, Section of Newborn Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.

Abstract

Background: Despite rising hepatitis C virus (HCV) prevalence among pregnant individuals in the United States, HCV testing among exposed infants remains low. Although recent guidelines recommend early RNA testing for HCV-exposed children to help improve testing rates, national studies describing factors associated with HCV testing and type of testing completed are lacking.

Methods: In this retrospective national study, we characterized HCV testing and care among HCV-exposed infants born 2010-2020 captured in the electronic health record-based TriNetX Research Network. We analyzed factors associated with appropriate HCV testing completion (negative or positive HCV RNA testing or negative HCV antibody testing at any age through study end in 2022) and with RNA compared with antibody testing, using univariable and multivariable logistic regression with clustered standard errors by healthcare organization.

Results: Of 8,516 HCV-exposed children, 45.8% completed any HCV testing and 42.1% completed appropriate testing (25% of whom had RNA testing only). 182 (5.1% of appropriately tested children) had evidence of HCV infection. Of 104 treatment-eligible children, 14.4% were treated. Black (OR 0.38, 95% CI 0.26-0.55), Asian/Pacific Islander (OR 0.06, 95% CI 0.03-0.11), and Hispanic/Latinx children (OR 0.56, 95% CI 0.36-0.88) had lower odds of appropriate testing compared with White and non-Hispanic/Latinx children, respectively.

Conclusions: Fewer than half of HCV-exposed children in this national sample were tested for HCV, with lower testing odds among Black, Asian/Pacific Islander, and Hispanic/Latinx children. Substantial work to increase testing and treatment and decrease disparities in testing among HCV-exposed children is needed to help reach US HCV elimination goals.