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Armini LN, Setiawati EP, Arisanti N, Hilmanto D. Evaluation of Process Indicators and Challenges of the Elimination of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B in Bali Province, Indonesia (2019-2022): A Mixed Methods Study. Trop Med Infect Dis 2023; 8:492. [PMID: 37999611 PMCID: PMC10674447 DOI: 10.3390/tropicalmed8110492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND This study was conducted to describe the prevalence of and evaluate the processes and challenges in implementing the elimination of HIV, syphilis, and hepatitis B transmission from mother to child in Bali Province, Indonesia. METHODS The research method used is a descriptive approach using indicators and a set of processes by the WHO, quantitative methods using descriptive analysis, and qualitative methods using phenomenological paradigms through in-depth interviews and FGD with healthcare professionals involved in the elimination of mother-to-child transmission (EMTCT) program. RESULTS The indicators that have successfully met the target for 4 years are antiretroviral therapy (ART) coverage in Badung District (≥95%) and ANC coverage (at least one visit) in Buleleng District (≥95%). The study found low prevalence rates of HIV, syphilis, and hepatitis B among pregnant women in the three districts. There are some indicators that show improvement from 2019 to 2022, namely, syphilis (60.44% to 86.98%) and hepatitis B (29.03% to 95.35%) screening coverage showed improvements, with increasing screening rates observed in Buleleng District. However, adequate treatment coverage for pregnant women with syphilis decreased in Denpasar City in 2022 compared to 2019 (100% to 71.28%). Despite data on hepatitis B treatment being unavailable, hepatitis B vaccination coverage exceeded the WHO target in all three districts. The utilization of the information system is not yet optimal, and there is a lack of ability to track cases. Furthermore, there is insufficient involvement of the private sector, particularly in screening, and a lack of standardized procedures in the management of referrals for pregnant women with hepatitis B. CONCLUSION The prevalence of HIV, syphilis, and hepatitis B among pregnant women has consistently remained below the Ministry of Health's target for four years. Despite this, there are a lot of targets, and the indicator EMTCT process has yet to reach the WHO target. The challenges for each district in reaching the WHO target include providing syphilis and hepatitis B reagents and benzatine penicillin; increasing private sector involvement; and strengthening information systems, policies, and guidelines for the management of hepatitis B among pregnant women in line with WHO recommendations to achieve EMTCT.
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Affiliation(s)
- Luh Nik Armini
- Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Sumedang 45363, Indonesia;
- Midwifery Science Program, Faculty of Medicine, Universitas Pendidikan Ganesha, Bali 81116, Indonesia
| | - Elsa Pudji Setiawati
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang 45363, Indonesia;
| | - Nita Arisanti
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang 45363, Indonesia;
| | - Dany Hilmanto
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang 45363, Indonesia;
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Pham TTH, Maria N, Cheng V, Nguyen B, Toy M, Hutton D, Conners EE, Nelson NP, Salomon JA, So S. Gaps in Prenatal Hepatitis B Screening and Management of HBsAg Positive Pregnant Persons in the U.S., 2015-2020. Am J Prev Med 2023; 65:52-59. [PMID: 36906494 PMCID: PMC10994214 DOI: 10.1016/j.amepre.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND The Advisory Committee for Immunization Practices (ACIP) recommends testing all pregnant women for hepatitis B surface antigen (HBsAg) and testing HBsAg-positive pregnant women for hepatitis B virus deoxyribonucleic acid (HBV DNA). HBsAg-positive pregnant persons are recommended by the American Association for the Study of Liver Diseases to receive regular monitoring, including alanine transaminase (ALT) and HBV DNA and antiviral therapy for active hepatitis and to prevent perinatal HBV transmission if HBV DNA level is >200,000 IU/mL. METHODS Using Optum Clinformatics Data Mart Database claims data, pregnant women who received HBsAg testing and HBsAg-positive pregnant persons who received HBV DNA and alt testing and antiviral therapy during pregnancy and after delivery during January 1, 2015-December 31, 2020 were analyzed. RESULTS Among 506,794 pregnancies, 14.6% did not receive HBsAg testing. Pregnant women more likely to receive testing for HBsAg (p<0.01) were persons aged ≥20 years, were Asian, had >1 child, or received education beyond high school. Among the 0.28% (1,437) pregnant women who tested positive for hepatitis B surface antigen, 46% were Asian. The proportion of HBsAg-positive pregnant women who received HBV DNA testing during pregnancy and in the 12 months after delivery was 44.3% and 28.6%, respectively; the proportion that received hepatitis B e antigen was 31.6% and 12.7%, respectively; the proportion that received ALT testing was 67.4% and 47%, respectively; and the proportion that received HBV antiviral therapy was 7% and 6.2%, respectively. CONCLUSIONS This study suggests that as many as half a million (∼14%) pregnant persons who gave birth each year were not tested for HBsAg to prevent perinatal transmission. More than 50% of HBsAg-positive persons did not receive the recommended HBV-directed monitoring tests during pregnancy and after delivery.
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Affiliation(s)
- Thi T Hang Pham
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Nimisha Maria
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Vivian Cheng
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Brandon Nguyen
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Mehlika Toy
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - David Hutton
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Erin E Conners
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Noele P Nelson
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joshua A Salomon
- Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Samuel So
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California.
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Higgins DM, O'Leary ST. Prevention of Perinatal Hepatitis B Transmission. Obstet Gynecol Clin North Am 2023; 50:349-361. [PMID: 37149315 DOI: 10.1016/j.ogc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Hepatitis B virus (HBV) is efficiently transmitted to newborn infants in the perinatal period and can lead to chronic infection, cirrhosis, liver cancer, and death. Despite the availability of effective prevention measures necessary to eliminate perinatal HBV transmission, significant gaps remain in the implementation of these prevention measures. All clinicians who care for pregnant persons and their newborn infants need to know the key prevention measures including (1) identification of HBV surface antigen (HBsAg)-positive pregnant persons, (2) antiviral treatment of HBsAg-positive pregnant persons with high viral loads, (3) timely postexposure prophylaxis of infants born to HBsAg-positive persons, (4) and timely universal vaccination of newborn infants.
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Affiliation(s)
- David M Higgins
- Department of Pediatrics, University of Colorado School of Medicine, Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado/Children's Hospital Colorado, Mailstop F443, 1890 North Revere Court, Aurora, CO 80045, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine, Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado/Children's Hospital Colorado, Mailstop F443, 1890 North Revere Court, Aurora, CO 80045, USA.
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Deng HMA, Romero N, Allard N, Rowe S, Yussf N, Cowie B. Uptake of perinatal immunoprophylaxis for infants born to women with a record of hepatitis B in Victoria (2009-2017). Vaccine 2023; 41:1726-1734. [PMID: 36759283 DOI: 10.1016/j.vaccine.2023.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/22/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains one of the leading causes of transmission worldwide. An estimated 90 % of infants who are exposed to HBV and do not receive appropriate post exposure immunoprophylaxis will go on to develop chronic hepatitis B (CHB). In Australia, universal birth dose vaccination was adopted in 2000 and universal antenatal screening for hepatitis B was introduced in the 1990 s, however up to 10 % of women may have missed screening. There is no coordinated care or data collection that systematically reports the access to interventions to prevent mother-to-child transmission (PMTCT) for women with CHB. Therefore, the incidence rate of MTCT is unknown. METHODS We conducted retrospective data linkage of perinatal records, public health notification and hospital admission data to identify women with a record of HBV infection who had given birth to a live infant(s) in Victoria between 2009 and 2017. We assessed uptake of birth dose vaccination and hepatitis B immunoglobulin (HBIG) and explored factors associated with administration of birth dose recorded as administered within 7 days. RESULTS Among 690,052 live births, 6118 births (0.90 %) were linked to 4196 women with a record of HBV infection. 89.4 % of all Victorian infants (n = 616,879), and 96.8 % of infants linked to women with a positive record of CHB (n = 5,925) received birth dose within 7 days. Infants born in private hospitals had reduced odds of receiving birth dose when compared to public hospitals births (Victorian population, aOR = 0.67, 95 %CI = 0.66, 0.69; CHB linked records aOR = 0.17, 95 %CI = 0.11, 0.25). Of the 6118 infants linked to a positive maternal record of CHB, discrepant recording of maternal CHB status between the three datasets was identified in 72.4% of records and HBIG administration was recorded for only 2.3% of births. CONCLUSION An approach that involves coordinated care and integrates data collection for women with CHB and their infants is required to support the elimination of MTCT of hepatitis B in Victoria.
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Affiliation(s)
- Hui Min-Anna Deng
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia.
| | - Nicole Romero
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia; State Government Department of Health, Victoria, Australia
| | - Nicole Allard
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia
| | - Stacey Rowe
- State Government Department of Health, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Australia
| | - Nafisa Yussf
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia; State Government Department of Health, Victoria, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia; State Government Department of Health, Victoria, Australia; Royal Melbourne Hospital, Melbourne, VIC, Australia
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Schwartz J, Bocour A, Tang L, Pene F, Johnson N, Lazaroff J, Moore MS, Winters A. Telephone Patient Navigation Increases Follow-Up Hepatitis B Care in the Postpartum Period for Immigrants Living in New York City. J Immigr Minor Health 2021; 23:1179-1186. [PMID: 34313899 DOI: 10.1007/s10903-021-01240-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
Hepatitis B is a major public health threat which leads to serious liver disease or cancer and disproportionately impacts immigrants. Pregnant people are routinely tested for hepatitis B to prevent perinatal transmission but may themselves not receive appropriate education and referrals. People contacted as part of the local health department's perinatal hepatitis B prevention program were offered culturally appropriate telephone patient navigation services to test if this would improve adherence with postpartum hepatitis B care. Four-hundred and nine people were enrolled in the intervention. Using laboratory-reported surveillance data as the outcome measure, those receiving the intervention were 1.66 times as likely to see a hepatitis B care provider within 6 months of childbirth compared with those who did not. Culturally appropriate patient navigation can improve adherence with recommended hepatitis B care in the postpartum period. Health departments can use similar interventions to address liver health disparities in immigrant populations.
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Affiliation(s)
- Jessie Schwartz
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, 42-09 28th Street, Long Island City, NY, USA.
| | - Angelica Bocour
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, 42-09 28th Street, Long Island City, NY, USA
| | - Liz Tang
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, 42-09 28th Street, Long Island City, NY, USA
| | - Farma Pene
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, 42-09 28th Street, Long Island City, NY, USA
| | - Nirah Johnson
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, 42-09 28th Street, Long Island City, NY, USA
| | - Julie Lazaroff
- New York City Department of Health and Mental Hygiene, Bureau of Immunization, Long Island City, NY, USA
| | - Miranda S Moore
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, 42-09 28th Street, Long Island City, NY, USA
| | - Ann Winters
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, 42-09 28th Street, Long Island City, NY, USA
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