Identifying gaps across the cascade of care for the prevention of HBV mother‐to‐child transmission in Burkina Faso: Findings from the real world

Abstract

Background: Prevention of mother-to-child transmission (PMTCT) is a challenge for controlling the hepatitis B epidemic. In Sub-Saharan countries, pilot interventions including the screening of pregnant women for HBsAg, implementation of anti-HBV therapy and infant immunization within 24 hours of life are initiated and need to be evaluated. This pilot study aimed to describe the cascade of care for hepatitis B PMTCT in a real life situation, and to identify sociodemographic factors associated with adequate management of pregnant women and infants. Method: The study was conducted from October 1st, 2014 to February 28th, 2016 in the antenatal clinics (ANCV) of Baskuy district which comprises nine first-level public health centres. Univariate and multivariate logistic regression analysis were used to identify sociodemographic factors associated with the likelihood of retention in the cohort, HBV DNA testing, birth dose delivery and HBsAg testing of the children at 6 months of age; P ˂ .05 was selected as cut off for significance. Results: In this prospective cohort study, of 5200 pregnant women consulting for the antenatal visit, 2261 (43.5%) were proposed pre-test counselling and HBsAg screening and 2220 (98.2%) have agreed to screening. Among 1580 (71.2%) women that came back for the post-counselling interview, 75 were positive for HBsAg (4.8%), 73 (97.3% of the women provided HBsAg result) consented to medical consultation with hepatogastroenterologists and 53 (72.6%); performed the HBV DNA testing. Forty-seven out of 60 (78.3%; 65.8-87.9) children born alive were immunized for HBV within 24 hours of life. Retention in care was associated with the level of education of the infant's father, secondary school or higher was associated with a better retention in care of the women (OR: 6.6; P = .03). Conclusion: Our study shows large gaps in HBV PMTCT. Resources for hepatitis B screening, care and prevention including universal access to the vaccine birth dose should be allocated to reduce infection in HBV exposed infants born in Burkina Faso. How to cite this article: Guingané AN, Bougouma A, Sombié R, et al. Identifying gaps across the cascade of care for the prevention of HBV mother-to-child transmission in Burkina Faso: Findings from the real world.

Arresting vertical transmission of hepatitis B virus (AVERT-HBV) in pregnant women and their neonates in the Democratic Republic of the Congo: a feasibility study

“…This package of interventions is delivered routinely in high resource settings, but infrequently across Africa. Integration of activities into existing HIV prevention of mother-to-child transmission and Expanded Programme on Immunisation infra structure distinguishes our approach from a recently published feasibility study of an antenatal HBV programme in Burkina Faso, 8 and our study yielded a higher uptake of HBV screening at the first antenatal visit. We longitudinally followed up HBV-infected women and their exposed infants to document adherence to the care cascade, side-effects of birth-dose vaccine and tenofovir disoproxil fumarate, and the incidence of mother-to-child transmission.…”

“…However, the feasibility of providing antiviral prophylaxis for HBV mono-infected pregnant women in low-resource settings in sub-Saharan Africa is not well established. Only one study 8 was done in Burkina Faso, which attempted to address this issue; this study found large gaps in HBV prevention of mother-to-child transmission and did not attempt to leverage the existing HIV prevention of motherto-child transmission programme.…”

Rapid Diagnostic Test for Hepatitis B Virus Viral Load Based on Recombinase Polymerase Amplification Combined with a Lateral Flow Read-Out

“…The major risk of failure of this treatment is the presence of a high viral load in the pregnant woman [5][6][7][8][9][10]. Prevalence of HBs antigen positive (HBsAg+) pregnant women ranges from 3.2% in Eritrea, 4.8% in Burkina Faso to 11% in Republic of South Soudan [11,12]. Among them, about 7.5% in Burkina Faso [11], 5.6% in the Democratic Republic of the Congo [7], and 5.2% in Mozambique [13] have an elevated viral load.…”

“…Prevalence of HBs antigen positive (HBsAg+) pregnant women ranges from 3.2% in Eritrea, 4.8% in Burkina Faso to 11% in Republic of South Soudan [11,12]. Among them, about 7.5% in Burkina Faso [11], 5.6% in the Democratic Republic of the Congo [7], and 5.2% in Mozambique [13] have an elevated viral load. However, administrating the birth dose of HBV vaccine is frequently logistically difficult, making the HBV MTCT prevention program suboptimal.…”

“…To overcome Diagnostics 2022, 12, 621 2 of 10 these difficulties, the European Association for the Study of the Liver [3] and the American Association for the Study of Liver Diseases [14] recommend initiating antiviral therapy in pregnant women with HBV viral loads greater than 2 × 10 5 IU/mL between 28 weeks and 32 weeks of gestation [5] to prevent mother-to-child transmission. African countries such as Burkina Faso have initiated programs including treatment of highly viremic mothers to strengthen the prevention of HBV MTCT [11]. In addition, other countries were engaged in this way, performing feasibility study for arresting vertical transmission of HBV [7] or piloting an intervention of the prevention of HBV MTCT [13].…”