A decision analytic model for prevention of hepatitis B virus infection in Sub‐Saharan Africa using birth‐dose vaccination

Anderson, Steven J.; Dionne-Odom, Jodie; Halle-Ekane, Gregory; Tita, Alan T.N.

doi:10.1002/ijgo.12434

Cited by 17 publications

(23 citation statements)

References 20 publications

(32 reference statements)

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“…Compared to published models of other vaccine-preventable diseases [23], there is a marked deficit in the existing evidence for HBV, with few other modelling efforts represented in the literature [24, 25]. Reassuringly, our findings are consistent with those of another recent simulation of HBV prevention [19]; we concur in concluding that current vaccine-based interventions will result in a modest reduction in HBV prevalence by the year 2030.…”

Section: Discussionsupporting

confidence: 85%

HBV vaccination and PMTCT as elimination tools in the presence of HIV: insights from a clinical cohort and dynamic model

McNaughton

Lourenço

Hattingh

et al. 2019

BMC Med

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Background Sustainable Development Goals set a challenge for the elimination of hepatitis B virus (HBV) infection as a public health concern by the year 2030. Deployment of a robust prophylactic vaccine and enhanced interventions for prevention of mother to child transmission (PMTCT) are cornerstones of elimination strategy. However, in light of the estimated global burden of 290 million cases, enhanced efforts are required to underpin optimisation of public health strategy. Robust analysis of population epidemiology is particularly crucial for populations in Africa made vulnerable by HIV co-infection, poverty, stigma and poor access to prevention, diagnosis and treatment. Methods We here set out to evaluate the current and future role of HBV vaccination and PMTCT as tools for elimination. We first investigated the current impact of paediatric vaccination in a cohort of children with and without HIV infection in Kimberley, South Africa. Second, we used these data to inform a new parsimonious model to simulate the ongoing impact of preventive interventions. By applying these two approaches in parallel, we are able to determine both the current impact of interventions, and the future projected outcome of ongoing preventive strategies over time. Results Existing efforts have been successful in reducing paediatric prevalence of HBV infection in this setting to < 1%, demonstrating the success of the existing vaccine campaign. Our model predicts that, if consistently deployed, combination efforts of vaccination and PMTCT can significantly reduce population prevalence (HBsAg) by 2030, such that a major public health impact is possible even without achieving elimination. However, the prevalence of HBV e-antigen (HBeAg)-positive carriers will decline more slowly, representing a persistent population reservoir. We show that HIV co-infection significantly reduces titres of vaccine-mediated antibody, but has a relatively minor role in influencing the projected time to elimination. Our model can also be applied to other settings in order to predict impact and time to elimination based on specific interventions. Conclusions Through extensive deployment of preventive strategies for HBV, significant positive public health impact is possible, although time to HBV elimination as a public health concern is likely to be substantially longer than that proposed by current goals. Electronic supplementary material The online version of this article (10.1186/s12916-019-1269-x) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 85%

HBV vaccination and PMTCT as elimination tools in the presence of HIV: insights from a clinical cohort and dynamic model

McNaughton

Lourenço

Hattingh

et al. 2019

BMC Med

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“…In Cameroon, universal HBV vaccination with birth dose may be the most effective strategy in terms of reducing pediatric HBV infection by age 10 at a willingness to pay threshold of $150. 46 Similarly, universal HBV vaccination with birth dose was the least costly HBV prevention option in a population in Thailand with maternal seroprevalence of 7%. 116 Provision of HBIG for infants born to HBV infected women in Thailand was cost-effective at a willingness-to-pay threshold of $1200.…”

Section: Resultsmentioning

confidence: 99%

Elimination of Vertical Transmission of Hepatitis B in Africa: A Review of Available Tools and New Opportunities

Dionne-Odom

Njei

Tita

2018

Clinical Therapeutics

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Scale-up of currently available tools is required to reach HBV disease-elimination goals in SSA. Many countries in SSA are in the process of rolling out national birth-dose vaccination campaigns; this roll out provides an opportunity to evaluate and improve processes in order to expand coverage. Early antenatal care, promotion of facility deliveries, and increased awareness of HBV prevention are also key components of prevention success. Future studies in SSA should identity an HBV-prevention package that is effective, well tolerated, and feasible and can be administered in the antenatal clinic and tailored to vertical-transmission risk.

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“…Facility, cold chain Facility, CTC Community, cold chain Community, CTC Community, CPAD cost-effective ness of expanding hepatitis B birth dose provision has already been shown, 7,41 but the analyses rarely considered alternatives to standard cold chain practices or the greater reach of community-based lay health workers, or both. The use of CTC and CPAD could provide means to overcome the common barriers of human resources and cold chain limits, and we show that, when used in conjunction with existing infrastructure, CTC and CPAD maintain or enhance the cost-effectiveness of achieving birth dose coverage targets.…”

Section: Sub-saharan Africamentioning

confidence: 99%

Use of controlled temperature chain and compact prefilled auto-disable devices to reach 2030 hepatitis B birth dose vaccination targets in LMICs: a modelling and cost-optimisation study

Seaman

Morgan

Howell

et al. 2020

The Lancet Global Health

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Background Hepatitis B causes more than 800 000 deaths globally each year. Perinatal infections are a major driver of this burden but can be prevented by vaccination within 24 h of birth. Currently, only 44% of newborn babies in lowincome and middle-income countries (LMICs) receive a timely birth dose. We investigated the effects and costeffectiveness of implementing ambient storage of hepatitis B vaccines under a controlled temperature chain (CTC) protocol and the use of compact prefilled auto-disable (CPAD) devices for community births. Methods In this mathematical modelling study of perinatal hepatitis B transmission and disease progression, we estimated the coverage impact and cost-effectiveness of implementing CTC and CPAD interventions in the sixGlobal Burden of Disease (GBD) regions containing LMICs. Combinations of four different scenarios of birth dose delivery strategies (cold chain, CTC) and interventions (needle and syringe, CPAD) were modelled across facility or community birth locations. We also estimated the minimum cost and most cost-effective strategy to achieve the WHO 90% hepatitis B birth dose coverage target in GBD regions and in 46 LMICs with a reported coverage of less than 90%. Findings Current delivery protocols achieved a maximum coverage of 65% (IQR 64-65) across GBD regions. Reaching 90% hepatitis B birth dose coverage across all GBD regions was estimated to cost a minimum of US$687•5 million per annum ($494•0 million more than the estimated current expenditure), of which $516•5 million (75%) was required for CTC and CPAD interventions. Reaching 90% coverage in this way was estimated to be cost saving in five of the six regions (and in 40 of 46 LMICs individually assessed) due to the disease costs averted, with the cost per disability-adjusted life-years averted being less than $83•27 otherwise. Interpretation Hepatitis B birth dose coverage of 90% is unlikely to be reached under current protocols. CTC and CPAD vaccine strategies present cost-effective solutions to overcome coverage barriers. Funding The Burnet Institute.

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A decision analytic model for prevention of hepatitis B virus infection in Sub‐Saharan Africa using birth‐dose vaccination

Abstract: Including a birth-dose HBV vaccine in the standard schedule was both cost-effective and prevented additional infections.

Cited by 17 publications

References 20 publications

HBV vaccination and PMTCT as elimination tools in the presence of HIV: insights from a clinical cohort and dynamic model

HBV vaccination and PMTCT as elimination tools in the presence of HIV: insights from a clinical cohort and dynamic model

Elimination of Vertical Transmission of Hepatitis B in Africa: A Review of Available Tools and New Opportunities

Use of controlled temperature chain and compact prefilled auto-disable devices to reach 2030 hepatitis B birth dose vaccination targets in LMICs: a modelling and cost-optimisation study

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