Association of Postpartum Inpatient Consultation Compared With Outpatient Referral With Hepatitis C Virus Treatment Completion.
| Title: | Association of Postpartum Inpatient Consultation Compared With Outpatient Referral With Hepatitis C Virus Treatment Completion. |
|---|---|
| Authors: | McCrary LM; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Leydh Z; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Curtis MR; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Elrod-Gallegos J; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Kojima P; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Karpman L; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Cain J; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Vora K; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Bongu J; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Habrock-Bach T; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Durkin MJ; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Trammel C; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Kelly JC; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.; Marks LR; Division of Infectious Diseases and the Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri. |
| Source: | O&G open [O G Open] 2025 Sep 11; Vol. 2 (5), pp. e112. Date of Electronic Publication: 2025 Sep 11 (Print Publication: 2025). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 9918787579406676 Publication Model: eCollection Cited Medium: Internet ISSN: 2994-9726 (Electronic) Linking ISSN: 29949726 NLM ISO Abbreviation: O G Open Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Philadelphia, PA] : Wolters Kluwer Health, Inc., [2024]- |
| Abstract: | Objective: 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.; Methods: 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.; Results: 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).; Conclusion: 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.; (© 2025 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American College of Obstetricians and Gynecologists.) |
| References: | Clin Infect Dis. 2025 Jul 18;80(6):e100-e102. (PMID: 39569427); J Gen Intern Med. 2014 Apr;29(4):636-45. (PMID: 24474651); Clin Res Hepatol Gastroenterol. 2017 Feb;41(1):39-45. (PMID: 27542514); J Gen Intern Med. 2023 Nov;38(15):3428-3433. (PMID: 37653211); Clin Infect Dis. 2024 Mar 20;78(3):582-590. (PMID: 37992203); Obstet Gynecol. 2022 May 1;139(5):916-918. (PMID: 35576352); Ann Intern Med. 2017 May 02;166(9):637-648. (PMID: 28319996); Clin Infect Dis. 2024 Dec 17;79(6):1428-1436. (PMID: 39356149); EClinicalMedicine. 2024 Jul 13;74:102727. (PMID: 39109190); Lancet Gastroenterol Hepatol. 2021 Mar;6(3):169-184. (PMID: 33515496); Am J Obstet Gynecol. 2008 Jul;199(1):38.e1-9. (PMID: 18486089); Int J Drug Policy. 2024 May;127:104396. (PMID: 38593518); Matern Child Health J. 2006 Nov;10(6):511-6. (PMID: 16807794); Obstet Gynecol. 2023 Sep 1;142(3):449-456. (PMID: 37590978); MMWR Recomm Rep. 2020 Apr 10;69(2):1-17. (PMID: 32271723) |
| Entry Date(s): | Date Created: 20250926 Date Completed: 20250926 Latest Revision: 20250928 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12456482 |
| DOI: | 10.1097/og9.0000000000000112 |
| PMID: | 41000407 |
| Database: | MEDLINE |
Journal Article