Around 50 million people worldwide carry long-term hepatitis C, and infected pregnant women can pass the virus to their baby during pregnancy or childbirth. The UK National Screening Committee currently does not recommend testing all pregnant women for hepatitis C, because the evidence is too thin. Researchers do not know how many pregnant women in the UK have the virus, how often it passes to the baby, how well current tests work in pregnancy, or whether antiviral treatments are safe and effective for pregnant women and their children. This project will create an evidence map—a systematic catalogue of existing studies and guidelines—to show what is known and where the gaps are. If the map reveals enough reliable evidence, it could lead to a full review of whether universal antenatal screening would improve outcomes. That could change a quiet but consequential piece of NHS infrastructure: the national screening programme for pregnant women. Better screening could catch infections earlier, prevent liver damage in mothers, and stop babies from being born with a chronic disease that can cause liver failure or cancer decades later. If the evidence is insufficient, the map will also make that clear, saving the NHS from investing in a programme that might cause more harm than good through false alarms or unnecessary treatment.
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An evidence map to outline the volume and type of evidence related to antenatal screening for hepatitis C virus to the UK National Screening Committee What is hepatitis C virus? Hepatitis C virus (HCV) is an infection that affects the liver. The liver clears harmful substances from the blood. When HCV damages the liver, toxins build up in your blood to cause tiredness, fever, nausea, stomach ache, and not feeling hungry or wanting to eat. It can also cause skin and eyes to go yellow. This is known as jaundice, which is often associated with liver problems. Some people with HCV do not have any symptoms. Sometimes, HCV can be short-term and get better by itself. Most of the time the infection lasts a long time and needs treatment with medications to get rid of the virus. Around 50 million people in the world are estimated to have long-term HCV infection. If HCV is not treated, the liver can be damaged which can lead to liver failure, where the liver stops working properly, or liver cancer. Antiviral medications are used to treat HCV infection by killing the HCV. HCV is spread when a person comes into contact with blood infected with the virus. This might happen if a person shares a needle with someone who has HCV, usually when injecting drugs. It may also happen if a person is given infected blood during a blood transfusion, where donated blood is given for medical reasons. This is uncommon in the UK now because blood donated by individuals is checked to make sure it is safe to give to another person before it is used. It is more common in some other countries and was more common in the UK before the 1980s-1990s. Pregnant women with HCV can pass it on to their baby during pregnancy or childbirth. Testing all pregnant women for HCV (screening) is not currently recommended by the UK National Screening Committee (UK NSC). This is because there is not enough evidence on the number of pregnant women in the UK that have HCV, what factors increase the likelihood of a pregnant person transferring the virus to their child, how well current tests for identifying HCV infection work, and how well treatments for HCV work in pregnant women and their children. We want to understand if a national programme that tests pregnant women without symptoms (screening) could lead to better outcomes for them and their babies, or if it would be better to keep the current approach to testing. Why might screening not be a good idea? All screening has the potential to cause harm as well as benefit. It can identify things that would never have caused problems, leading to unnecessary worry and treatment. Screening can sometimes raise false alarms when a test result suggests something is wrong but further tests show there’s no issue, which can be stressful. Some real cases can also be missed, which can give false reassurance and delay diagnosis and treatment. Before starting or changing any screening programme, we need to understand if it works better than not screening, or better than the current approach. What are we trying to find out? The UK National Screening Committee wants to find out whether screening for HCV infection during pregnancy would lead to better outcomes than the current approach for diagnosing HCV. As a first step, they need to check if there is enough reliable evidence to support exploring the topic in more depth. We’re looking at how many studies and what types of studies have looked at the following questions: • Are there any guidelines for screening for HCV during pregnancy in the UK or other countries? • How well do treatments for HCV work to prevent pregnant women from passing the infection to their baby or severe outcomes? • How well do treatments for HCV work in children who were infected during pregnancy to cure HCV infection, or prevent severe outcomes?
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