Prevention of mother-to-child transmission of hepatitis B virus in antenatal care and maternity services, Mozambique

Abstract

Objective To pilot an intervention on the prevention of mother-to-child transmission (PMTCT) of hepatitis B virus (HBV) in an antenatal care and maternity unit in Maputo, Mozambique, during 2017–2019. Methods We included HBV in the existing screening programme (for human immunodeficiency virus (HIV) and syphilis) for pregnant women at their first consultation, and followed mother–child dyads until 9 months after delivery. We referred women who tested positive for hepatitis B surface antigen (HBsAg) for further tests, including hepatitis B e antigen (HBeAg) and HBV viral load. According to the results, we proposed tenofovir for their own health or for PMTCT. We administered birth-dose HBV vaccine and assessed infant HBV status at 9 months. Findings Of 6775 screened women, 270 (4.0%) were HBsAg positive; in those for whom data were available, 24/265 (9.1%) were HBeAg positive and 14/267 (5.2%) had a viral load of > 200 000 IU/mL. Ninety-eight (36.3%) HBsAg-positive women were HIV coinfected, 97 of whom were receiving antiretroviral treatment with tenofovir. Among HIV-negative women, four had an indication for tenofovir treatment and four for tenofovir PMTCT. Of 217 exposed liveborn babies, 181 (83.4%) received birth-dose HBV vaccine, 160 (88.4%) of these < 24 hours after birth. At the 9-month follow-up, only one out of the 134 tested infants was HBV positive. Conclusion Our nurse-led intervention highlights the feasibility of integrating PMTCT of HBV into existing antenatal care departments, essential for the implementation of the triple elimination initiative. Universal birth-dose vaccination is key to achieving HBV elimination.

Prevalence of hepatitis B virus and immunity status among healthcare workers in Beira City, Mozambique

“…In Mozambique, although there are no national data for HBV prevalence, the HBsAg prevalence (4.7%) found in this study is similar to those recently found in Beira City among blood donors approved for donation (4.5%) [25] and in Maputo City (southern Mozambique) among pregnant women (4.0%). [11] A higher prevalence of HBsAg was found in studies conducted in the southern region of Mozambique among HIV-positive subjects (9.1%) [4] and youths (12.2%) [3]. Also, a study conducted among people who inject drugs in Maputo City and Nampula/Nacala (northern Mozambique), showed a high overall prevalence of HBsAg (32.8%) [26].…”

“…Mozambique presents high endemicity for HBV according to studies published in the Southern region of the country [3][4][5], and in countries with high endemicity, most of the infections are acquired perinatally from mother to child [31]. Recently, a study found a 4.0% prevalence of HBsAg in pregnant women in Maputo City, Mozambique [11]. The country has not implemented the vaccination dose at birth, and there are no data on the effectiveness of vaccination in children.…”

“…In Mozambique, hepatitis B vaccination in children has been part of the Expanded Programme on Immunization (EPI) since 2001, with the two-three-four months postnatal scheme. Although the current immunization coverage rate is high, with an estimate of 88%, the birth-dose vaccination has yet to be implemented [10,11].…”

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

“…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.…”

“…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]. This therefore requires knowledge of the HBV viral loads of women.…”