Hepatitis C Treatment Access With Implementation of an Antenatal Linkage-to-Care Bundle

OBJECTIVE: To evaluate a health system–wide quality-improvement bundle (HALT-C [hepatitis C antenatal linkage-to-care]) on its ability to integrate proactive patient identification, care coordination, and treatment timing options on direct-acting antiviral prescription by 6 months postpartum. METHODS: We implemented our quality-improvement initiative at a large midwestern health system and evaluated its effect by comparing outcomes among eligible pregnancies identified preimplementation (December 1, 2021–May 31, 2023) with those identified postimplementation (March 1, 2024–August 31, 2025). Eligible patients were aged at least 18 years, with detectable hepatitis C virus RNA and at least one encounter in the health system before 35 weeks of gestation. The primary outcome was the percentage of patients prescribed direct-acting antivirals by 6 months postpartum. Secondary outcomes included linkage to care, the treatment timing decision, treatment completion, sustained virologic response (SVR), infant screening, and perinatal transmission. Comparison of antenatal initiation of treatment and postpartum initiation of treatment was also performed. RESULTS: We identified 62 bundle-eligible pregnancies in the preimplementation period and identified 35 in the postimplementation period. Direct-acting antiviral prescription by 6 months postpartum increased from 48.4% to 77.1% ( P =.009); treatment completion improved from 21.0% to 54.3% ( P =.001). Treatment increases were greatest among patients who delivered regionally, rather than at the main hospital, with an increase in direct-acting antiviral prescription rates of 14.3% to 72.7% ( P <.001). Thirty of 35 individuals identified postimplementation were successfully linked to care, and 75.0% of clinic attendees preferred antenatal treatment over postpartum treatment. Known treatment completion and SVR increased from 21.0% to 54.3% ( P =.001). Those treated antenatally were twice as likely to complete treatment than those who deferred postpartum (92.3% vs 45.5%; P =.02). Infant screening and perinatal transmission rates did not change; however, no perinatal transmissions occurred among infants where treatment occurred antenatally. CONCLUSION: The HALT-C bundle was associated with significantly improved direct-acting antiviral receipt across a regional health system. Most patients preferred treatment during pregnancy. Patients treated antenatally were twice as likely to complete treatment, highlighting pregnancy as an important opportunity to initiate curative therapy.