Meds to Beds: A Hepatitis C Treatment Program for Inpatient Postpartum Mothers

A growing body of research highlights the effectiveness of initiating hepatitis C virus (HCV) treatment for postpartum mothers during their hospital stay, rather than relying on outpatient follow-up, which is an approach that has historically seen low engagement and completion rates.

“Standard referral only results in about 14% of women getting hepatitis C antivirals postpartum, so that's really low,” said Madeline McCrary, MD, assistant professor in the Division of Infectious Diseases, Washington University in St. Louis.“Nationwide, standard referral for Hep C treatment among Medicaid recipients, postpartum, is less than 6% so the strategy wasn't working.”

In addition, the postpartum phase for new mothers presents unique challenges that make follow-up care difficult. They are focused on caring for their newborns, and in some cases may be dealing with separation due to social or medical circumstances. Barriers include transportation, insurance loss, stigma, and the complexity of specialty pharmacy coordination further reduce the likelihood of attending clinic appointments.

These low rates prompted clinicians to rethink how and when care is delivered. To address these gaps, McCrary and her colleagues implemented a “meds-to-beds” model, where hepatitis C treatment for postpartum mothers was initiated before hospital discharge.

Their study was published in O&G Open, and it reviewed 149 pregnancies complicated by HCV. Of the total cohort, 125 women (83.9%) were referred for HCV treatment either during pregnancy or at delivery. Among them, 33 (26.4%) were referred through an inpatient model, while 92 (73.6%) were referred for outpatient care. Although all patients in the inpatient group received a consultation, more than half of those referred outpatient—55.4%—never presented for evaluation, highlighting a major drop-off in care engagement.¹

This disparity translated into markedly different treatment outcomes. Among women prescribed direct-acting antivirals (DAAs), those in the inpatient group had nearly double the treatment completion rate compared to outpatient care (66.7% vs 34.0%). After adjustment, inpatient care was associated with 4.7 times higher odds of completing treatment.¹

This “meds-to-beds” approach ensures that patients receive their full course of medication while still in a controlled care setting. By leveraging the guaranteed interaction during labor and delivery admission, providers can evaluate, prescribe, and physically deliver medications directly to patients.

“We'll send the medications there [pharmacy], and they'll bring it over right in time for the patient to be discharged with medications in hand,” McCrary said.

Importantly, in Missouri, where McCrary practices, there are no Medicaid restrictions on HCV treatment. “We don't have a prior authorization, and we can actually give the entire course of medication to patients up front,” she said.

When full treatment courses can be dispensed upfront, patients are more likely to complete therapy without interruptions. This is especially critical given that follow-up appointment attendance remains low.

While confirming cure can still be challenging due to inconsistent patient contact and follow-up, providers have adapted by utilizing opportunistic lab testing during future healthcare encounters and documenting outcomes accordingly.

Overall, the shift toward inpatient hepatitis C treatment represents a practical and impactful strategy to improve care delivery for postpartum mothers by meeting patients where they are and removing barriers at a critical moment in their healthcare journey.

In terms of scaling up, McCrary and her colleagues are working to expand the program to other hospitals.

“We're working with a statewide quality collaborative to create a toolkit for providers at other hospitals to be able to coordinate treatment at labor and delivery. The other thing is that we have implemented a treatment in pregnancy program. We have visits with patients who have hepatitis C while they're pregnant, and offer them the option to be treated in pregnancy vs postpartum, and that allows us to address everything before the labor and delivery admission.”

Reference
1.McCrary LM, Leydh Z, Curtis MR, et al. Association of Postpartum Inpatient Consultation Compared With Outpatient Referral With Hepatitis C Virus Treatment Completion. O G Open. 2025;2(5):e112. Published 2025 Sep 11. doi:10.1097/og9.0000000000000112