521. Patterns of Testing in Children Exposed Perinatally Exposed to Hepatitis C
Session: Poster Abstract Session: Hepatitis B and C in Varied Settings
Thursday, October 5, 2017
Room: Poster Hall CD
Background:

Kentucky (KY) has the 2nd highest rate of Hepatitis C (HCV) infections among pregnant women in the U.S, largely due to IV drug use. HCV screening is recommended in children born to those women. HCV-exposed infants are also at risk for HIV and syphilis as well as neonatal abstinence syndrome (NAS). A substantial portion of HCV-exposed children are insured by Medicaid. The patterns of testing in this population are unknown. We sought to assess HCV-exposed children pattern of testing for HCV and other perinatal infections in children insured by KY Medicaid

Methods:

We identified HCV-exposed infants (ICD-10-CM code Z20.5) insured by KY Medicaid from 10/1/15 to 9/30/16. The primary outcome was HCV testing by PCR [CPT 87520 (HCV, direct probe), 87521 (HCV, amplified probe), 87522 (HCV RNA, Quantitative)] or antibody (CPTs 86803-4). Testing for HIV (CPTs 86701, 86702, 87389, 87535), and syphilis (CPT 86592) was also recorded. NAS was defined as presence of ICD-10-CM code P96.1 in any diagnosis field. Descriptive statistics were used

Results:

During the study period, 625 children with 4005 [median 3, Interquartile range (IQR) 1-8] claims were HCV-exposed. The majority of children were white (393, 63%), non-Hispanic (420, 67%) and male (318, 51%). Patterns of testing are shown in the Table.

Medicaid claims for tests performed in children perinatally exposed to HCV

Test

Number of Children* (%)

Number of Tests

Median Age

(months) [IQR]

HCV PCR

69 (11)

77

3 [2, 6]

HCV antibody

11 (2)

12

6 [2, 8]

HIV PCR

30 (5)

32

2 [2, 3]

HIV antibody

8 (1)

9

2 [2, 3]

Syphilis

26 (4)

26

2 [2, 3]

* A child may have been tested for more than one infection during the study period

Among HCV-exposed, 197 (32%) were diagnosed with NAS; but only 3 (1.5%) of these children were tested for perinatal infections whereas 84 (19.6%) of children with no documented NAS were tested (p<0.001).

Conclusion:

The proportion of HCV-exposed infants with a claim for HCV testing is low in the KY Medicaid population; testing for other perinatally-acquired infections is even less common. Children with NAS were less likely to be tested. Statewide guidelines for appropriate testing in children with perinatal HCV exposure and NAS are urgently needed.

Claudia Espinosa, MD, MSc1, John Myers, PhD2 and Michael Smith, Smith1, (1)Pediatrics, University of Louisville, Louisville, KY, (2)University of Louisville, Louisville, KY

Disclosures:

C. Espinosa, Cempra: Investigator , Research grant
The Medicines company: Investigator , Research grant
Astrazeneca: Investigator , Research grant
Regeneron Pharmaceuticals, Inc: Investigator , Research grant
Multiple Industry Sponsors (Merck, Sanofi Pasteur, Novartis, GlaxoSmithKline, Pfizer, Gllead: Sub investigator , lunch and Research support

J. Myers, None

M. Smith, None

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