Antenatal linkage bundle increases hepatitis C treatment after pregnancy

A single-system quality-improvement study compared 62 eligible pregnancies before and 35 after introducing the HALT-C linkage-to-care bundle. Direct-acting antiviral prescription by six months postpartum rose from 48.4% to 77.1%, while treatment completion increased from 21.0% to 54.3%.

DAA prescription by six months postpartum rose to 77.1%.
Treatment completion increased from 21.0% to 54.3%.
Antenatal treatment was associated with greater completion.
Small, nonrandomized quality-improvement study; pregnancy data remain limited.

The HALT-C bundle combined proactive identification of pregnant patients with detectable hepatitis C virus (HCV) RNA, care coordination and appointments offering antenatal or postpartum treatment. Investigators compared eligible pregnancies before implementation (December 2021–May 2023) with those after implementation (March 2024–August 2025) at a large Midwestern health system. The primary outcome was direct-acting antiviral (DAA) prescription by six months postpartum; secondary outcomes included treatment completion, sustained virologic response, infant screening and perinatal transmission.

Among 62 preimplementation and 35 postimplementation pregnancies, DAA prescription increased from 48.4% to 77.1% (P=.009), and treatment completion from 21.0% to 54.3% (P=.001). After implementation, 30 of 35 patients were linked to care. Among clinic attendees, 75% preferred antenatal treatment. Completion was higher among those treated antenatally than among those deferring treatment until postpartum (92.3% vs 45.5%; P=.02). Infant screening and transmission rates did not change overall; no transmission was observed among infants whose mothers received antenatal treatment.

The findings suggest that proactive linkage and offering treatment timing options may improve treatment uptake in this setting. However, this was a small, nonrandomized before-and-after quality-improvement study, so the association does not establish that the bundle caused the improvement. Pregnancy-specific DAA evidence remains limited, and the source notes that these drugs are not specifically FDA-labeled for use during pregnancy.

In practice

For pregnant patients with detectable HCV RNA in a health system similar to the one studied, a coordinated pathway that identifies patients, links them to care and offers antenatal or postpartum treatment was associated with higher DAA prescription and completion. The study does not establish causation: it was a small, single-system before-and-after quality-improvement evaluation. Although antenatal treatment was associated with higher completion, pregnancy-specific DAA evidence remains limited and the drugs are not specifically FDA-labeled for use during pregnancy; the findings alone do not establish a change in treatment practice.

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Source

Obstetrics & Gynecology: Hepatitis C Treatment Access With Implementation of an Antenatal Linkage-to-Care Bundle ↗

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