Temporal Trends in Hepatitis C Virus Screening and Management in Pregnant Women and Infants Between 2014 and 2024 in San Francisco, California

INTRODUCTION: Universal hepatitis C virus (HCV) screening is now recommended during pregnancy, although rates of screening, confirmatory viral load testing, and HCV treatment during pregnancy and postpartum remain poorly described. METHODS: This was a retrospective chart review study of birthing parents and infants who delivered at the University of California, San Francisco and Zuckerburg San Francisco General Hospital between January 1, 2014, and December 31, 2024, using the Epic electronic health record system. Maternal outcomes included HCV antibody screening, confirmatory HCV viral load testing, referral to HCV specialty care, and receipt of antiviral therapy. Infant screening and additional obstetric and neonatal outcomes were also reported. RESULTS: During the study period, 41,951 pregnant women delivered at our 2 sites of whom 13,950 received HCV screening (33.3%) by antibody or RNA testing. Screening rates increased over time from 15.2% in 2014 to 69.1% in 2024 ( P < 0.001). Among 328 (2.4%) with a positive screening test, 293 (89.3%) tested positive via HCV antibody and 203 (69.3%) of these completed follow-up HCV RNA testing and 110 (54.2%) had confirmed viremia. Of these, 52 (47.3%) received subspecialty referral and 43 of 52 (82.7%) received antiviral therapy (2 during pregnancy, 41 postpartum). Overall, 67 of 110 (60.9%) viremic patients were lost to follow-up. Among 115 infants born to viremic mothers, 30 (26.1%) received HCV screening at a median age of 19.2 months (interquartile range 13.4-22.0). Three infants (10.0%) screened HCV antibody positive; 2 had undetectable RNA, and 1 experienced spontaneous viral clearance at 19 months. DISCUSSION: Despite increasing screening over time, substantial gaps persist in HCV screening, follow-up testing, and linkage to care for pregnant patients and their infants. High loss to follow-up and low infant screening rates highlight the urgent need to strengthen peripartum HCV care pathways to support maternal and pediatric cure and advance HCV elimination goals.