Evaluation of prenatal hepatitis C virus prevalence using universal screening, and linkage to care in a real-world setting in Ontario

Objectives International infectious disease/obstetrical societies have recently recommended universal hepatitis C virus (HCV) prenatal screening, and these same recommendations are forthcoming in Canada. At present, there is no formal analysis of universal HCV screening or linkage to care of pregnant people in Ontario. The objectives of our study were to determine the seroprevalence of HCV using two different methods to evaluate universal screening, as well as identify opportunities that may improve linkage to care. Methods To assess seroprevalence in a large urban area, we aimed to test 12 000 de-identified samples submitted for prenatal HIV testing in the catchment area of Toronto Public Health for HCV antibodies. Then, to assess the seroprevalence as well as the operational impact and follow-up in a real-world setting, we completed a quality improvement project (QIP) for one year at a large tertiary care obstetrical centre in London, Ontario. Results From 2019 to 2021, 11 999 de-identified samples were screened from Toronto with a seroprevalence of 0.40 (95% CI 0.29–0.53). In London, 5771 people were screened in 2021 with a seroprevalence of 0.55% (95% CI 0.38–0.78). Taken together, those ages 26–35 had the highest positivity; in the QIP, 9% had no documented risk-factor, and 59% of individuals were not linked to the next step in HCV care. Conclusions HCV prenatal seroprevalence in Ontario is comparable to hepatitis B virus, and ∼15–30-fold higher than HIV. Diagnosis in pregnancy is critical to facilitate referrals for treatment between pregnancies and could increase screening among children born to positive women.