Facilitating HCV Treatment through Tailored Prenatal Care for HCV Infected, Substance using Pregnant Women

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 DESCRIPTION (provided by applicant): Hepatitis C virus (HCV) infection is prevalent among a growing population of opioid dependent (OD) pregnant women. Illicit drug use and specifically, opioid use during pregnancy has increased dramatically over the last decade from 1.19 to 5.77 per 1,000 hospital births. Due to high rates of intravenous opioid use, 40-75% of OD pregnant women are infected with HCV and over 28% are newly diagnosed with HCV during pregnancy. Pregnancy and the postpartum period offer unique opportunities to identify, educate and engage HCV infected, substance using pregnant women. However, many HCV infected pregnant patients do not receive appropriate prenatal care and less than 2% initiate HCV treatment within one year following delivery. In this R21 application, we propose to qualitatively evaluate the perspectives of 3 key stakeholder groups (HCV infected OD patients, prenatal care providers and hepatologists) involved in the delivery of health care services to HCV infected OD pregnant and postpartum women to identify ways to improve HCV education and evaluation during pregnancy and facilitate HCV treatment after delivery. The specific aims are: 1) Conduct individual semi- structured interviews with HCV infected OD pregnant and postpartum patients to understand the perspectives of patients regarding HCV infection during pregnancy and barriers and facilitators to postpartum treatment; 2) Conduct individual semi-structured interviews with prenatal care providers and hepatologists to describe the perspectives of providers regarding optimal prenatal and postpartum care delivery for HCV infected OD patients. Qualitative approaches and stakeholder engagement have become a central component of the research process in an effort to improve not only the efficacy, but the effectiveness of interventions. The overall goal of this R21 project is to understand the factors that contribute to suboptimal prenatal care for women with HCV and identify ways to improve HCV education and evaluation during pregnancy. The qualitative findings from this proposal will (a) offer insight into strategies to foster inter-provider dialogue and care coordination among prenatal and specialist care providers, (b) identify content and messaging necessary to engage pregnant patients in improved HCV-related health behavior and encourage postpartum treatment, and (c) inform the design an innovative prenatal care intervention for patients with HCV infection which will be tested in a subsequent R01 application on rates of HCV treatment one year after delivery. The broad hypothesis of our study is that improving patient and provider HCV knowledge and awareness will maximize HCV identification and patient engagement during pregnancy and facilitate postpartum treatment for HCV infected, substance using women thereby improving the long-term health of two generations.