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Hepatitis C, a virus transmitted through blood that harms the liver, can lead to cirrhosis, hepatic cancer, liver incapacity, and mortality if not addressed. Although highly effective therapies are accessible, the incidence of hepatitis C infection remains considerable, especially among women of reproductive age, who represent over one-fifth of chronic hepatitis C cases worldwide. Within this demographic, new mothers exhibit particular susceptibility since treatment has typically necessitated outpatient follow-up visits during the often challenging postpartum phase.
Recently, a novel investigation regarding an innovative clinical initiative created by experts at Washington University School of Medicine in St. Louis indicates that providing postpartum mothers with hepatitis C the chance to commence antiviral therapy while still hospitalized post-delivery, and delivering treatment directly to their bedside prior to discharge, substantially enhances their likelihood of completing the regimen and achieving cure. The researchers determined that new mothers who consulted an infectious disease expert and received hepatitis C medication during their hospital stay were twice as likely to be cured compared to mothers who were given a referral for an outpatient follow-up visit.
The results are published on September 11 in Obstetrics & Gynecology Open.
“We were witnessing too many patients slip through the cracks solely due to conventional separations between what was addressed inpatient — labor and delivery — and outpatient — hepatitis C,” stated Laura Marks, MD, PhD, the principal author of the paper and an assistant professor in the Division of Infectious Diseases within the John T. Milliken Department of Medicine. “We collaborated across departments to ensure that when expectant patients arrive at Barnes-Jewish Hospital to give birth, they also have the option to receive treatment for a condition that, if untreated, can result in cancer.”
Disrupting the cycle
Patients are frequently diagnosed with hepatitis C during routine screenings throughout pregnancy, but treatment has traditionally been postponed until the postpartum phase. However, after delivery, women often fail to return for follow-up care to initiate the medication.
To disrupt this cycle, Marks, joined by Jeannie Kelly, MD, an associate professor in the Department of Obstetrics & Gynecology and head of the Division of Maternal-Fetal Medicine & Ultrasound, applied a “Meds to Beds” strategy: Rather than referring hepatitis C patients for outpatient follow-up treatment post-discharge, the obstetrics and maternal-fetal medicine teams initiated the necessary steps for an infectious disease specialist to commence therapy before the patients left the hospital.
To assess the efficacy of this joint strategy, Marks and lead author Madeline McCrary, MD, an assistant professor in the Division of Infectious Diseases, analyzed medical files of 149 mothers who gave birth at Barnes-Jewish Hospital between January 2020 and September 2023 and tested positive for hepatitis C. Depending on the timing and availability of infectious disease specialists, these women either received immediate hepatitis C treatment while still hospitalized postpartum or were referred to an outpatient infectious disease clinic or hepatology clinic following their discharge.
In total, two-thirds of patients who started treatment in the hospital successfully completed the entire treatment course — 2-3 months of antiviral therapy — in contrast to about one-third of the outpatient referral group. The researchers discovered that more than half of postpartum mothers in the outpatient referral group did not attend the follow-up appointment. Successful treatment completion was assessed through a lab test confirming that the patient was no longer positive for hepatitis C or through patient self-reporting that they had completed the full course of antiviral medication.
“Eradicating hepatitis C in these mothers creates a substantial ripple effect — it safeguards their health, their families, and future pregnancies,” Kelly remarked. “That is why we collaborated with our infectious disease colleagues to reconsider how we could bridge gaps in treatment. This recent study illustrates that simply bringing the medication to the patient’s bedside immediately following delivery greatly reduces the number of patients lost in the process.”
WashU Medicine’s Division of Infectious Diseases and Division of Maternal-Fetal Medicine have also allied to integrate infectious disease care into obstetric clinics, including the introduction of new guidelines advocating shared decision-making regarding hepatitis C treatment during pregnancy.
Expanding the ‘Meds to Beds’ initiative
Marks, Kelly, and their team are working on training physicians at WashU Medicine to implement this interdisciplinary “Meds to Beds” initiative, not only for postpartum mothers but for all patients with untreated hepatitis C. Since 2023, the medical professionals at WashU Medicine, led by Marks, have established a hepatitis C virus care navigation and treatment program at Barnes-Jewish that embraces the “Meds to Beds” approach and coordinates expedited post-treatment follow-ups in local communities to ensure patient recovery. This program has delivered medications to bedside for over 200 patients, representing a significant advancement in hepatitis C treatment.
Beyond WashU Medicine and Barnes-Jewish, Marks emphasizes the potential transferability of this novel method, which may also be beneficial for other infectious diseases.
“We cannot hesitate to explore a new care model when it could lead to improved health for the entire community,” Marks stated. “We are instructing our trainees to address what is directly in front of them, especially communicable diseases. As they finish the program here, we observe them being recruited to apply this effective model elsewhere. It’s a gradual journey, but based on the successes we are already witnessing, this momentum will keep growing over time.”
McCrary LM, Leydh Z, Curtis MR, Elrod-Gallegos J, Kojima P, Karpman L, Cain J, Vora K, Bongu J, Habrock-Bach T, Durkin MJ, Trammel C, Kelly JC, Marks L. Association between postpartum inpatient consultation versus outpatient referral with hepatitis C treatment completion. Obstetrics & Gynecology Open. September 11, 2025.
This research was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily reflect the official viewpoint of the NIH.
Dr. Kelly receives funding from NIDA (5R21DA057493-02, 1R61DA062321-01); NICHD (1R01HD113199-01). The funders had no involvement in the study’s design and execution; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
Drs. McCrary and Marks declare funding from Gilead’s Frontlines of Communities in the United States (FOCUS) program. FOCUS funding supports HIV, HCV, and HBV screening and linkage to the first medical appointment after diagnosis; FOCUS funding does not support any activities beyond the first medical appointment and is agnostic to how FOCUS partners handle subsequent patient care and treatment.
About Washington University School of Medicine
WashU Medicine is a prominent leader in academic medicine, encompassing biomedical research, patient care, and educational programs with 2,900 faculty members. Its National Institutes of Health (NIH) research funding portfolio is the second largest among U.S. medical schools and has increased by 83% since 2016. Along with institutional investments, WashU Medicine commits well over $1 billion annually to basic and clinical research innovation and training. Its faculty practice consistently ranks within the top five in the nation, with over 1,900 faculty physicians practicing across 130 sites. WashU Medicine physicians exclusively serve Barnes-Jewish and St. Louis Children’s hospitals — the academic hospitals of BJC HealthCare — and provide care to BJC’s community hospitals in the region. WashU Medicine has a distinguished history in MD/PhD training, having recently dedicated $100 million towards scholarships and curriculum enhancements for its medical students, and is home to outstanding training programs in every medical subspecialty as well as physical therapy, occupational therapy, and audiology and communications sciences.
Originally published on the WashU Medicine website.
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