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BACKGROUND: Despite rising hepatitis C virus (HCV) prevalence among pregnant individuals in the United States, HCV testing among exposed infants remains low. Although recent guidelines recommend early RNA testing for HCV-exposed children to help improve testing rates, national studies describing factors associated with HCV testing and type of testing completed are lacking. METHODS: In this retrospective national study, we characterized HCV testing and care among HCV-exposed infants born 2010-2020 captured in the electronic health record-based TriNetX Research Network. We analyzed factors associated with appropriate HCV testing completion (negative or positive HCV RNA testing or negative HCV antibody testing at any age through study end in 2022) and with RNA compared with antibody testing, using univariable and multivariable logistic regression with clustered standard errors by healthcare organization. RESULTS: Of 8,516 HCV-exposed children, 45.8% completed any HCV testing and 42.1% completed appropriate testing (25% of whom had RNA testing only). 182 (5.1% of appropriately tested children) had evidence of HCV infection. Of 104 treatment-eligible children, 14.4% were treated. Black (OR 0.38, 95% CI 0.26-0.55), Asian/Pacific Islander (OR 0.06, 95% CI 0.03-0.11), and Hispanic/Latinx children (OR 0.56, 95% CI 0.36-0.88) had lower odds of appropriate testing compared with White and non-Hispanic/Latinx children, respectively. CONCLUSIONS: Fewer than half of HCV-exposed children in this national sample were tested for HCV, with lower testing odds among Black, Asian/Pacific Islander, and Hispanic/Latinx children. Substantial work to increase testing and treatment and decrease disparities in testing among HCV-exposed children is needed to help reach US HCV elimination goals.
RESUMEN
OBJECTIVES: Sexually transmitted infections (STIs) cause significant morbidity among women with HIV and increase HIV transmission. We estimated the prevalence of four STIs among women with HIV in sub-Saharan Africa (SSA) and compared prevalence among women with and without HIV. DESIGN: Systematic review and meta-analysis. METHODS: We searched for studies published 1 January 1999 to 19 December 2019 reporting prevalence of gonorrhea, chlamydia, trichomoniasis, or Mycoplasma genitalium among women with HIV in SSA. We excluded studies conducted in high-risk groups (e.g. female sex workers). We extracted data on laboratory-confirmed STIs among women with HIV, and when included, among women without HIV. We estimated pooled prevalence for each STI among women with HIV using inverse variance heterogeneity meta-analysis, compared prevalence to women without HIV, and examined the influences of region, clinical setting, and pregnancy status in subgroup analyses. RESULTS: We identified 3756 unique records; 67 studies were included in the meta-analysis. Prevalence of gonorrhea, chlamydia, trichomoniasis, and M. genitalium was 3.5, 4, 15.6, and 10.2%, respectively. Chlamydia prevalence was lower in Eastern (2.8%) than in Southern (12.5%) and West/Central (19.1%) Africa combined. Prevalence of chlamydia and trichomoniasis was higher among pregnant (8.1%, 17.6%) than nonpregnant (1.7%, 12.3%) women. All STIs were more prevalent among women with than without HIV (relative risks ranging 1.54-1.89). CONCLUSION: STIs are common among women with HIV in SSA, and more common among women with than without HIV. Integrated STI and HIV care could substantially impact STI burden among women with HIV, with potential downstream impacts on HIV transmission.