{"doi":"10.1093/cid/ciaf578","title":"Gaps in the Hepatitis C Prenatal and Postpartum Care Cascade: Rationale for Treatment in Pregnancy","abstract":"BACKGROUND: Hepatitis C virus (HCV) infections have increased among younger populations, including pregnant people. While universal screening guidelines have improved case-finding, studies suggest low postpartum linkage-to-care rates. Better understanding of the peripartum HCV care cascade at the population level is needed to inform optimal management, including the role of treatment in pregnancy. METHODS: A retrospective cohort study linking pregnant individuals with HCV test records to health administrative data in Ontario, Canada. We examined the HCV care continuum, including during subsequent pregnancies. We used Andersen-Gill models to examine predictors of missed opportunities for treatment, defined as pregnancies occurring before/in absence of treatment, and initiating treatment. RESULTS: From 2003 to 2021, we identified 42 797 pregnancies in 16 888 people who tested HCV antibody-positive between 1999 and 2021. Of antibody-positive individuals, 14 538 (86.1%) had RNA testing and 7457 (51.3%) tested RNA-positive. Treatment uptake was 1.1%, 2.5%, and 5.2% at 1, 2, and 5 years after RNA positivity. Ultimately, 3861 (51.8%) initiated treatment and 2277 (30.5%) demonstrated sustained virologic response. Among those with confirmed chronic HCV, 47.5% (n = 3025) experienced a missed opportunity for treatment, with 19.2% (n = 1221) having multiple missed opportunities. Numbers of pregnancies and diagnosis year pre-2012 were associated with higher likelihood of a missed opportunity for treatment, while diagnoses of substance use disorder, HIV, and chronic disease were associated with lower likelihood. CONCLUSIONS: Despite diagnosis, <10% initiated treatment within 5 years of RNA positivity and multiple pregnancies occurred before treatment, resulting in repeated exposures. Additional efforts will be required to ensure linkage-to-care and treatment either during pregnancy or postpartum.","journal":"Clinical Infectious Diseases","year":2025,"id":584730,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9638,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":706063,"name":"Jennifer A. Flemming","orcid":"0000-0002-9911-0925","position":1,"is_corresponding":false},{"id":439745,"name":"Tatyana Kushner","orcid":"0000-0001-6663-6253","position":2,"is_corresponding":false},{"id":1497854,"name":"William Wong","orcid":"0000-0003-4630-0052","position":3,"is_corresponding":false},{"id":1497855,"name":"Zoë R. Greenwald","orcid":"0000-0001-7942-3951","position":4,"is_corresponding":false},{"id":611833,"name":"Wenbin Li","orcid":"0000-0002-4072-5300","position":5,"is_corresponding":false},{"id":744675,"name":"Bo Chen","orcid":"0000-0002-9926-4377","position":6,"is_corresponding":false},{"id":361803,"name":"Jeffrey C. Kwong","orcid":"0000-0002-7820-2046","position":7,"is_corresponding":false},{"id":1498245,"name":"Chelsea Masterman","orcid":null,"position":8,"is_corresponding":false},{"id":1498246,"name":"Camelia Capraru","orcid":null,"position":9,"is_corresponding":false},{"id":28335,"name":"Jordan J. Feld","orcid":"0000-0003-2640-2211","position":10,"is_corresponding":false},{"id":28337,"name":"Mia J. Biondi","orcid":"0000-0002-1409-9908","position":11,"is_corresponding":false},{"id":1497853,"name":"Andrew Mendlowitz","orcid":"0000-0002-0178-5087","position":0,"is_corresponding":true}],"reference_count":34,"raw_metadata":null,"created_at":"2026-07-19T02:59:16.166424Z","pmid":"41363839","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}