Article Text
Abstract
In the USA, there are missed opportunities to diagnose hepatitis C virus (HCV) in pregnancy because screening is currently risk-stratified and thus primarily limited to individuals who disclose history of injection drug use or sexually transmitted infection risks. Over the past decade, the opioid epidemic has dramatically increased incidence of HCV and a feasible, well-tolerated cure was introduced. Considering these developments, recent evidence suggests universal HCV screening in pregnancy would be cost-effective and several professional organisations have called for updated national policy. Historically, universal screening has been financially disincentivised on the healthcare system level, particularly since new diagnoses may generate an obligation to provide expensive treatments to a population largely reliant on public health resources. Here, we provide ethical arguments supporting universal HCV screening in pregnancy grounded in obligations to respect for persons, beneficence and justice. First, universal prenatal HCV screening respects pregnant women as persons by promoting their long-term health outside of pregnancy. Additionally, universal screening would optimise health outcomes within current treatment guidelines and may support research on treatment during pregnancy. Finally, universal screening would avoid potential harms of risk-stratifying pregnant women by highly stigmatised substance use and sexual behaviours.
- health care economics: interests of woman/fetus/father
- ostetrics and gynecology
- public health ethics: drugs and drug industry
Statistics from Altmetric.com
Footnotes
Twitter @GYNOBioethicist
Contributors MSG conceptualised the project, performed literature review, wrote primary draft of the manuscript and contributed to final manuscript edits. ARR performed extensive literature review, assisted in ethical analysis, and manuscript preparation and editing. SAR contributed to the conceptualisation of the project, provided subject-specific expertise and critically revised the manuscript. All authors approved of the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement There are no (new) data in this work; all can be found in referenced publications.
Read the full text or download the PDF:
Other content recommended for you
- Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study
- Reconsidering the management of patients with cancer with viral hepatitis in the era of immunotherapy
- Prevalence of hepatitis C among pregnant women attending an inner London obstetric department: uptake and acceptability of named antenatal testing
- Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic
- Changes in hepatitis C burden and treatment trends in Europe during the era of direct-acting antivirals: a modelling study
- Cost and cost-effectiveness of a real-world HCV treatment program among HIV-infected individuals in Myanmar
- Hepatitis C in pregnancy
- Towards HCV elimination among people who inject drugs in Hai Phong, Vietnam: study protocol for an effectiveness-implementation trial evaluating an integrated model of HCV care (DRIVE-C: DRug use & Infections in ViEtnam–hepatitis C)
- Clinical effectiveness of pharmacy-led versus conventionally delivered antiviral treatment for hepatitis C in patients receiving opioid substitution therapy: a study protocol for a pragmatic cluster randomised trial
- On the path towards universal coverage of hepatitis C treatment among people receiving opioid agonist therapy (OAT) in Norway: a prospective cohort study from 2013 to 2017