{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:04:05Z","timestamp":1792785845268,"version":"4.5.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011593","name":"ICES","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100025092","name":"Ontario Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100025092","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100025090","name":"Ministry of Long-Term Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100025090","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["202109PSS"],"award-info":[{"award-number":["202109PSS"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012264","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23 HL163486"],"award-info":[{"award-number":["K23 HL163486"]}],"id":[{"id":"10.13039\/501100012264","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Canadian Network on Hepatitis C","award":["NPC-178912"],"award-info":[{"award-number":["NPC-178912"]}]},{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatitis C virus (HCV) infections have increased among younger populations, including pregnant people. While universal screening guidelines have improved case-finding, studies suggest low postpartum linkage-to-care rates. Better understanding of the peripartum HCV care cascade at the population level is needed to inform optimal management, including the role of treatment in pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study linking pregnant individuals with HCV test records to health administrative data in Ontario, Canada. We examined the HCV care continuum, including during subsequent pregnancies. We used Andersen-Gill models to examine predictors of missed opportunities for treatment, defined as pregnancies occurring before\/in absence of treatment, and initiating treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 2003 to 2021, we identified 42 797 pregnancies in 16 888 people who tested HCV antibody-positive between 1999 and 2021. Of antibody-positive individuals, 14 538 (86.1%) had RNA testing and 7457 (51.3%) tested RNA-positive. Treatment uptake was 1.1%, 2.5%, and 5.2% at 1, 2, and 5 years after RNA positivity. Ultimately, 3861 (51.8%) initiated treatment and 2277 (30.5%) demonstrated sustained virologic response. Among those with confirmed chronic HCV, 47.5% (n = 3025) experienced a missed opportunity for treatment, with 19.2% (n = 1221) having multiple missed opportunities. Numbers of pregnancies and diagnosis year pre-2012 were associated with higher likelihood of a missed opportunity for treatment, while diagnoses of substance use disorder, HIV, and chronic disease were associated with lower likelihood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite diagnosis, &amp;lt;10% initiated treatment within 5 years of RNA positivity and multiple pregnancies occurred before treatment, resulting in repeated exposures. Additional efforts will be required to ensure linkage-to-care and treatment either during pregnancy or postpartum.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf578","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T12:27:28Z","timestamp":1761222448000},"page":"e521-e533","source":"Crossref","is-referenced-by-count":3,"title":["Gaps in the Hepatitis C Prenatal and Postpartum Care Cascade: Rationale for Treatment in Pregnancy"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0178-5087","authenticated-orcid":false,"given":"Andrew B","family":"Mendlowitz","sequence":"first","affiliation":[{"name":"Toronto Centre for Liver Disease\/Viral Hepatitis Care Network (VIRCAN), University Health Network , Toronto ,","place":["Canada"]},{"name":"ICES, Queen's University , Kingston ,","place":["Canada"]},{"name":"Institute of Health Policy, Management, and Evaluation, University of Toronto , Toronto ,","place":["Canada"]},{"name":"School of Health Policy & Management, York University , Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A","family":"Flemming","sequence":"additional","affiliation":[{"name":"ICES, Queen's University , Kingston ,","place":["Canada"]},{"name":"Department of Medicine, Queen's University , Kingston ,","place":["Canada"]},{"name":"Department of Public Health Sciences, Queen's University , Kingston ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6663-6253","authenticated-orcid":false,"given":"Tatyana","family":"Kushner","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, David H. Koch Center, Weill Cornell Medicine , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William W L","family":"Wong","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Waterloo , Waterloo ,","place":["Canada"]},{"name":"ICES , Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7942-3951","authenticated-orcid":false,"given":"Zo\u00eb R","family":"Greenwald","sequence":"additional","affiliation":[{"name":"ICES , Toronto ,","place":["Canada"]},{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto ,","place":["Canada"]},{"name":"Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital , Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenbin","family":"Li","sequence":"additional","affiliation":[{"name":"ICES, Queen's University , Kingston ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Chen","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease\/Viral Hepatitis Care Network (VIRCAN), University Health Network , Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7820-2046","authenticated-orcid":false,"given":"Jeffrey C","family":"Kwong","sequence":"additional","affiliation":[{"name":"ICES , Toronto ,","place":["Canada"]},{"name":"Communicable Disease Control, Public Health Ontario , Toronto ,","place":["Canada"]},{"name":"Department of Family and Community Medicine, University of Toronto , Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea","family":"Masterman","sequence":"additional","affiliation":[{"name":"Arthur Labatt Family School of Nursing, Western University , London 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