The rate of maternal hepatitis C virus (HCV) infections increased 137% compared with 12% between pre- and post-implementation of a needle-exchange program in Ohio. This 125% rate difference is according to data published in the American Journal of Perinatology.
A population-based retrospective cohort study of all live births in Ohio between 2006 and 2015 was conducted to quantify the prevalence of maternal HCV before and after implementation of a needle exchange program in Scioto County Ohio, which ran from 2012 to 2015.
Throughout the study period, 7069 cases were reported at the time of delivery among 1,463,506 births in the state of Ohio. In Scioto County, the mean rate of maternal HCV between 2006 and 2011 was 1.3% (95% CI, 1.1–1.5) and 2.3% (95% CI, 2.1–2.6) between 2012 and 2015. In total, this pre-intervention demonstrated a 137% increase in the rate of maternal HCV infections in Scioto County. The rate of increase in the 4 years following implementation of the program decreased to 12%. The rate of increase also dropped precipitously in counties directly adjacent to Scioto, whereas regional counties continued to show substantial increases.
Results also demonstrated that after the implementation of the exchange program there was also a decreased composite neonatal adverse events such as admission to a neonatal intensive care unit, low 5-minute Apgar scores, assisted ventilation, as well as surfactant, and antibiotic administration (adjusted relative risk, 0.3; 95% CI, 0.2–0.3). Moreover, maternal adverse events such as intensive care unit admission, need for transfusion, or unplanned operations also decreased.
This study was limited in that data came from birth records and did not contain records of maternal drug use or participation in the exchange program. Therefore, there are limits to the conclusions that can be drawn. This is especially significant because poor pregnancy outcomes are associated with heroin use in pregnancy. Due to the retrospective nature of the work the investigators were also unable to make conclusions on the causality of between the programs initiation and differences in observed rates of maternal HCV.
The results did show a dramatic change in infection trajectory after the needle exchange program implementation in Scioto County and neighboring counties. Investigators also concluded that they could demonstrate an association between implementation of the program and decreased adverse neonatal and maternal events compared with regional counties.
Rossi RM, Brady MJ, Hall ES, Warshak CR. Effect of needle exchange program on maternal hepatitis C virus prevalence [published online January 21 2020]. Am J Perinatol. doi:10.1055/s-0039-3402753