Hepatitis C infection often co-occurs with substance use disorders in pregnancy. Accessing hepatitis C treatment is challenging due to loss to follow up in the postpartum period, attributable to social and financial barriers to care. Telemedicine has been explored as a means of increasing routine postpartum care, but the potential impact on retention in and completion of care for postpartum hepatitis C has not been assessed.
To evaluate the impact of hepatitis C on obstetric morbidity in a substance use disorder specific prenatal clinic, as well as the effect of Infectious Disease telemedicine consultation on subsequent treatment delivery.
We performed a retrospective cohort study of all patients in our substance use disorder prenatal clinic from June 2018-February 2023. Telemedicine consults for hepatitis C diagnoses began in March 2020 and included electronic chart review by Infectious Disease when patients were unable to be seen. Our primary outcome was composite obstetric morbidity (preterm birth, pre-eclampsia, fetal growth restriction, fetal anomaly, abruption, postpartum hemorrhage, or chorioamnionitis) compared between patients with and without active hepatitis C. We additionally evaluated rates of completed referral and initiation of hepatitis C treatment before and after implementation of telemedicine consult.
224 total patients were included. Of the 222 patients who underwent screening, 71 (32%) were positive for active hepatitis C. Compared to patients without hepatitis C, a higher proportion of patients with hepatitis C were white, (80% vs 58%, P=0.02), had a history of amphetamine use (61% vs 32%, p <0.01), injection drug use (72% vs 38%, p<0.01), prior overdose (56% vs 29%, p <0.01), and were on methadone (37% vs 18%, p <0.01).. There was no difference in the primary outcome of composite obstetric morbidity. The rate of hepatitis C diagnosis was not statistically different in the pre- and post-telemedicine cohorts, (N= 29 (41%), N=42 (27%)), and demographics of HCV positive patients were similar, with a majority unemployed, single, and publicly insured. A lower proportion of patients in the post-telemedicine group reported heroin use than in the pre-telemedicine cohort (62% vs 90%, p=0.013). After implementation of telemedicine, patients were more likely to attend the visit (19% vs 44%, p=0.03) and positive patients were much more likely to receive treatment (14% vs 57%, p<0.01). 100% of visits in the post-telemedicine group occurred via telemedicine. 7 patients were prescribed treatment by their obstetrician after chart review by Infectious Disease.
Patients with and without hepatitis C had similar maternal and neonatal outcomes, with multiple indicators of social and financial vulnerability. Telemedicine Infectious Disease consult was associated with increased follow up and hepatitis C treatment, and obstetricians were able to directly prescribe. Because patients with substance use disorders and hepatitis C may have increased barriers to care, telemedicine may represent an opportunity for intervention.

Copyright © 2023. Published by Elsevier Inc.