59 - Predictors of lost to follow-up for pregnant individuals with HCV and perinatal HCV exposed children

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 59
Publication Number: 59.215

Grecio J. Sandoval, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD, United States

Presenting Author(s)

GS

Grecio J. Sandoval, PhD (he/him/his)

Assistant Research Professor
for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Rockville, Maryland, United States

Background: Rates of testing and follow-up among pregnant individuals with hepatitis C virus (HCV) and their children remain low.

Objective: We aim to develop an internally validated prediction model to identify participants that are likely to be lost to follow-up (LTFU) in a clinical study setting.

Design/Methods: This is a secondary analysis of a multicenter observational study of HCV in pregnancy. Participants were eligible if they were HCV-antibody positive. For child LTFU, participants with a fetal loss were excluded. Participants were LTFU if no prenatal or delivery admission HCV testing was performed. Children were LTFU if no HCV testing was performed within 24 months of age. Potential factors for maternal LTFU included known information prior to delivery. For child LTFU, known factors prior to delivery discharge were also considered (Table 1). Bootstrap resampling with backward elimination method was used to develop logit models (1000 bootstrap samples). Candidate models were based on the frequency of each candidate factor and the final predictor model was based on goodness of fit and predictive ability.

Results: Of 772 participants, 366 (47%) participants and 132/744 (18%) children were considered LTFU. Predictors of maternal LTFU included: medication-assisted treatment (aOR 2.04, 95% CI 1.48 – 2.81), married or living with partner (aOR 0.60, 95% CI 0.43 – 0.82), any infections (aOR 0.66, 95% CI 0.47 – 0.91), and income < $10,000 (aOR 1.42, 95% CI 1.03 – 1.95). For child LTFU, predictors included: maternal HCV RNA titer during pregnancy > 10^6 IU/mL (aOR 0.45, 95% CI 0.27 – 0.74), child adopted or placed in foster care (aOR 9.02, 95% CI 4.06 – 20.05), and maternal LTFU (aOR 2.06, 95% CI 1.38 – 3.08). AUC-ROCs were 0.64 (95% CI 0.60 – 0.68) and 0.67 (95% CI 0.62 – 0.72) for maternal and child LTFU, respectively, yielding probabilities that ranged from 7% to 75% (Table 2).

Conclusion(s): We developed prediction models to identify HCV positive pregnant individuals and their children that are likely to be lost to follow-up. This may be a useful tool to aide in designing and evaluating interventions to improve follow-up of these individuals and their children.