Trends in testing for hepatitis C during pregnancy among persons with Medicaid and commercial insurance, 2015–2019 (Preprint)

BACKGROUND The reported incidence of acute hepatitis C virus (HCV) infection is increasing among reproductive age persons in the United States. Infants born to pregnant persons with HCV infection are at risk for perinatal HCV acquisition. Hepatitis C testing during pregnancy was evaluated during 2015 –2019. OBJECTIVE We estimated hepatitis C testing rates in a large sample of patients with Medicaid and commercial insurance who gave birth during 2015–2019 and described demographic and risk-based factors associated with testing. METHODS Medicaid and commercial insurance claims for patients ages 15–44 years who gave birth between 2015 and 2019 were included. Birth claims were identified using procedure and diagnosis codes for vaginal or cesarean delivery. Hepatitis C testing was defined as an insurance claim during the 42 weeks before delivery. Testing rates were calculated among patients who delivered and among the subset of patients who were continuously enrolled for 42 weeks before delivery. Multivariable logistic regression was used to identify factors associated with testing. RESULTS Among 1,142,770 Medicaid patients and 1,207,132 commercially insured patients, 15.3% and 18.3% were tested for hepatitis C during pregnancy, respectively. Testing rates were 21.8% and 21.9% among continuously enrolled Medicaid and commercially insured patients, respectively. Rates increased from 2015 through 2019 among Medicaid (from 19.2% to 26.8%) and commercially insured patients (from 18.1% to 28.0%), respectively. Among Medicaid patients, non-Hispanic Black and Hispanic race/ethnicity were associated with lower odds of testing. Opioid use disorder, HIV infection, and high-risk pregnancy were associated with higher odds of testing in both Medicaid and commercially insured patients. CONCLUSIONS Hepatitis C testing during pregnancy increased from 2015 through 2019 among patients with Medicaid and commercial insurances although tremendous opportunity for improvement remains.