Hepatitis C is rarely treated in high-risk postpartum Medicaid recipients

04/07/2022

And – despite the availability of a pill that cures the disease – less than a fifth of these patients received follow-up care for their hepatitis C diagnosis within six months of giving birth, scientists report today in the May issue of the journal. Obstetrics and Gynecology.
JarlenskiMarian“When we first saw these results, we thought, ‘This is way too low a treatment rate and there must be an error in our analysis,'” said lead author Marian Jarlenski, Ph. .D., MPH, Associate Professor of health policy and management at Pitt Public Health. “But then I thought about my own experiences with referrals to specialist doctors and it made sense. Navigating the medical system to get an appointment with an infectious disease specialist, particularly after childbirth and while managing a chronic condition, such as substance use, can be incredibly challenging.
the Distributed Medicaid Outcomes Research Network, led by study co-author Julie Donohue, Ph.D., professor and chair of health policy and management at Pitt Public Health, obtained anonymized and normalized data from the six states included in this study: Pennsylvania, West Virginia, Kentucky, Delaware, North Carolina and Maine. Data from 23,780 Medicaid recipients with a diagnosis of opioid use disorder and a live or stillborn child between 2016 and 2019 were analyzed.

About 70% of people included in the study were tested for hepatitis C, and 31% of them were diagnosed with the virus. At three months postpartum, 3.2% of them had received a follow-up visit or medication to treat the virus, and at six months that rate had only increased to 5.9%.

US bailout law — signed in 2021 — created a pathway that goes into effect this month to allow states to extend Medicaid coverage to pregnant women for up to a full year after giving birth, theoretically allowing someone who discovered that she had hepatitis C during her pregnancy to seek treatment after giving birth.

“But what we’re finding is that it’s not that easy – as our research shows, telling a new parent they have Hep C and need to make an appointment with a specialist infectious diseases just doesn’t translate into a cure,” Jarlenski said. “Now more than ever, with universal screening for hepatitis C in pregnancy, the existence of a pill that cures this devastating disease, and the expansion of postpartum Medicaid coverage to pay for this treatment, it is essential to find a sustainable path to care.”

Co-authors on this research are Qingwen Chen, MS, Lu Tang, Ph.D., and Elizabeth E. Krans, MD, M.Sc., all of Pitt; Katherine A. Ahrens, Ph.D., MPH, of University of Southern Maine; Lindsay Allen, Ph.D., MA, of West Virginia University; Anna E. Austin, Ph.D., and Paul Lanier, Ph.D., MSW, both University of North Carolina-Chapel Hill; Lindsay Hammerslag, Ph.D., and Jeffrey Talbert, Ph.D., both University of Kentucky; and Mary Joan McDuffie, MPH, of University of Delaware.

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CREDIT: Pitt Public Health

CAPTION: Marian Jarlenski, Ph.D., MPH, associate professor of health policy and management at the University of Pittsburgh School of Public Health

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