A University of Alberta team has revamped Alberta’s prenatal hepatitis C screening program based on their research, uncovering more new cases of the bloodborne viral infection and streamlining the path to care for mothers and babies.
The researchers tested a new one-step blood screening tool, introduced a universal screening program and improved followup to ensure pregnant patients are connected with specialists, resulting in 59 per cent more cases of hepatitis C being identified for treatment.
Previously, only pregnant women who self-declared risk factors such as intravenous drug use or sex work were tested for hepatitis C using a two-step blood test. About 12 per cent of 50,000 newly pregnant Albertans were tested during their pregnancy under the risk disclosure system. Ninety-nine per cent are now being screened through the new universal program, with accurate results available within four days instead of 39 thanks to the new one-sample test and direct followup to connect patients with specialists.
Thirty-four cases of maternal hepatitis C were identified in the final year of the old program, while 54 cases were diagnosed in the pilot year for the improvements.
“People who are affected by hepatitis C are often marginalized populations and so it was really hard for them to get the initial screening done, then get the doctor’s appointment and phlebotomy for that second followup, and then also go see their doctor for those results,” explains Carmen Charlton, associate professor in the Department of Laboratory Medicine and Pathology.
“There were many pitfalls in the cascade of care that we could improve, and I saw that we could fill this gap,” says Charlton, who took over as program lead for hepatitis C screening at Alberta Precision Laboratories about a decade ago.
“The Alberta prenatal screening program screens pregnant women in their first trimester for sexually transmitted and bloodborne infections like HIV, hepatitis B, chlamydia, gonorrhea, syphilis — and now hepatitis C — so it is a very robust program,” says PhD student Alexa Thompson, who joined Charlton’s research team in 2019.
Hepatitis C is a confounding disease because 95 per cent of cases can be cured with antiviral treatments, yet the disease remains underdiagnosed because it often shows no symptoms for decades, and is often detected only once it has caused cirrhosis of the liver or liver cancer. Prevalence of hepatitis C is relatively low in Canada at just over one per cent of the population, but the rate is higher in vulnerable populations. Hepatitis C led to nearly 300,000 deaths worldwide in 2019, according to the World Health Organization, which aims to reduce new hepatitis infections by 90 per cent and deaths by 65 per cent by 2030. Researchers at the U of A are among those working to find a vaccine.
Though the cost of the universal, one-step prenatal screening program is higher than the previous two-step, risk-based program, Charlton notes that cost is outweighed by the prevented costs associated with treating patients for cirrhosis and cancer. Women who receive a diagnosis during pregnancy must wait until after they give birth to begin treatment, and infants who acquire hepatitis C from their mothers can take treatment once they are two years old.
Alberta is the second province after Saskatchewan to offer universal prenatal screening for hepatitis C, and started using the one-step blood test four years ahead of new guidelines issued last month by the U.S. Centers for Disease Control and Prevention. Charlton and Thompson hope their research will lead to a change in Canada’s national guidelines for prenatal hepatitis C screening. Thompson will next study whether outcomes for hepatitis C patients in Alberta get better thanks to the improved screening. Charlton is investigating simpler one-step blood tests for hepatitis B and HIV.
This research was funded by the Stollery Children’s Hospital Foundation and the Alberta Women’s Health Foundation through the Women and Children’s Health Research Institute. Alexa Thompson is a Vanier Scholar, winner of the Izaak Walton Killam Memorial Scholarship, the Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship, and the University of Alberta Doctoral Recruitment Scholarship. Carmen Charlton is also supported by the M.S.I. Foundation and is a member of the Women and Children’s Health Research Institute.
