Racial and Ethnic Disparities in Testing of Hepatitis C Virus-Exposed Children Across the United States

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 ribonucleic acid (RNA) testing for HCV-exposed children to help improve testing rates, national studies describing factors associated with HCV testing and the type of testing completed are lacking. Methods: In this retrospective national study, we characterized HCV testing and care among HCV-exposed infants born between 2010 and 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 8516 HCV-exposed children, 45.8% completed any HCV testing and 42.1% completed appropriate testing (25% of whom had RNA testing only). A total of 182 (5.1% of appropriately tested children) had evidence of HCV infection. Of 104 treatment-eligible children, 14.4% were treated. Black (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.26-0.55), Asian/Pacific Islander (OR: 0.06, 95% CI: 0.03-0.11), and Hispanic/Latinx (OR: 0.56, 95% CI: 0.36-0.88) children had lower odds of appropriate testing compared with White and non-Hispanic/Latinx children. 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.