Tenofovir Adherence in the Prevention of Mother-to-Child Transmission of Hepatitis B in the Democratic Republic of the Congo: A Qualitative Study Applying the Information-Motivation-Behavioral Skills Model

Abstract Background: Hepatitis B virus (HBV) remains a leading infectious cause of death worldwide, and is highly prevalent in Sub-Saharan Africa (SSA). The prevention of mother-to-child transmission (PMTCT) programs for HBV are critical to reaching elimination targets and utilizing existing HIV testing and treatment infrastructure. Building on a feasibility study to introduce tenofovir disoproxil fumarate antiviral therapy to pregnant women with high-risk HBV in the Democratic Republic of the Congo (DRC), we examine the social and psychological facilitators of medication adherence of women who participated in this HBV PMTCT program.Methods: This study utilizes a qualitative exploratory approach involving women in Kinshasa, DRC who were identified as high-risk HBV during pregnancy and completed the pilot tenofovir antiviral program. Six participants were identified and completed in-depth, open-ended phone interviews. This study adopts a modified Information-Motivation-Behavioral Skills model (IMB+) to identify emerging themes related to tenofovir adherence.Results: A strong trust in healthcare workers, family support, and improved awareness of the disease and treatment options through enrollment in the PMTCT program facilitated tenofovir adherence. Barriers to medication adherence included social stigma and low healthcare literacy specific to HBV.Conclusions: Our study highlights the feasibility of medication adherence in HBV PMTCT programs in a low-resource setting and the importance of incorporating initiatives that address hepatitis B stigma and other social barriers. These findings are relevant to future HBV PMTCT scale-up, which is needed in the DRC and in similar African contexts with high HBV prevalence. Trial registration: The parent study was registered with clinicaltrials.gov under identifier NCT03567382. Date of registration: 25/06/2018

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Socio-Structural Factors Influencing the Prevention of Mother-to-Child Transmission of HIV in the Democratic Republic of the Congo: A Systematic Review

Maternal and Child Health Journal ◽

10.1007/s10995-018-2688-6 ◽

2019 ◽

Vol 23 (7) ◽

pp. 880-889 ◽

Cited By ~ 2

Author(s):

Guy-Lucien S. Whembolua ◽

Baraka Muvuka ◽

Daudet Ilunga Tshiswaka ◽

Donaldson F. Conserve

Keyword(s):

Systematic Review ◽

Democratic Republic ◽

Structural Factors ◽

Mother To Child Transmission ◽

Child Transmission ◽

Factors Influencing ◽

Republic Of The Congo ◽

Mother To Child

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1144. Prevention of Mother-to-Child Transmission of Hepatitis B at UNC Hospitals

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1330 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S599-S599

Author(s):

Wesley M Sayre

Keyword(s):

Viral Load ◽

High Risk ◽

Hepatitis B ◽

Chart Review ◽

Laboratory Evaluation ◽

Mother To Child Transmission ◽

Child Transmission ◽

High Risk Women ◽

Hbv Vaccination ◽

Mother To Child

Abstract Background Hepatitis B virus (HBV) contributes to liver-related morbidity and mortality on a global scale. In mothers with active hepatitis B, up to 100% of mother-to-child-transmission (MTCT) is preventable. Guidelines from the American Association for the Study of Liver Diseases (AASLD) recommend that HBV vaccination and hepatitis B immunoglobulin (HBIG) be given to HBV-exposed infants in a timely manner to prevent up to 90% of MTCT. Additionally, AASLD guidelines recommend that women with high-risk HBV (those with viral load >200,000 IU/mL and/or HBV e antigen [HBeAg] positivity) receive tenofovir prophylaxis to further prevent MTCT. In this chart review, we compared UNC Hospital’s prevention of MTCT measures to standing AASLD guidelines. Methods This retrospective chart review included data from all HBV-positive mothers giving birth at UNC Hospitals from April 1, 2014 through December 31, 2019. We investigated the HBV status of mothers, time to neonatal HBV vaccination, time to HBIG administration, maternal HBV viral load, maternal HBeAg status, and whether tenofovir was provided for high-risk mothers. Data was then compared to AASLD guidelines distributed in January 2017. Results We identified 99 HBV-positive pregnant women over a five-year period. The rate of timely administration of HBIG was 99%. The rate of timely hepatitis B vaccination was 97%. The single neonate who did not receive the HBV vaccination within 12 hours was born to a mother whose HBV testing was initially positive but confirmatory testing was negative. Most (65%) women had documented HBV viral load and 75% of women had HBeAg studies. Nine women were identified as high-risk, with only one not receiving tenofovir. Conclusion UNC Hospitals were compliant with AASLD guidelines regarding timely neonatal vaccination, providing nearly 99% of neonates with timely HBIG and all but three neonates with timely HBV vaccine. The majority of high-risk women identified received tenofovir prophylaxis. However, there is room for improvement in laboratory evaluation to identify other high-risk women. While initial data is reassuring, quality improvement measures include improving testing rate to determine risk status for HBV-positive mothers and further investigation of appropriate follow-up testing for both mothers and children. Disclosures All Authors: No reported disclosures

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Update in management of hepatitis B in pregnancy and prevention of mother to child hepatitis B transmission

Thai Journal of Hepatology ◽

10.30856/th.jhep2018vol1iss3_01 ◽

2018 ◽

Vol 1 (3) ◽

pp. 1-8

Author(s):

Naichaya Chamroonkul

Keyword(s):

Chronic Hepatitis ◽

Viral Load ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

High Viral Load ◽

World Population ◽

Hepatitis B Infection ◽

Mother To Child Transmission ◽

Child Transmission ◽

Mother To Child

Even with two decades of widespread using hepatitis B vaccination, chronic hepatitis B remains a major global health problem. In Thailand, the prevalence of chronic hepatitis B infection was down from 8 - 10% in last decade to 5% recently. Failure to control mother to child transmission is one of the important barriers to the total elimination of hepatitis B infection from world population. In the majority, vertical transmission can be prevented with a universal screening program, immunoprophylaxis by administration of hepatitis B vaccine and hepatitis B immunoglobulin (HBIg) for babies born to mothers with HBV. However, in mothers with a high viral load, the chance of immunoprophylaxis failure remains high. To date, there are standard recommendations by all international liver societies including AASLD, EASL and APASL suggest introducing an antiviral agent during the third trimester to CHB pregnant women with a high viral load. Previous US FDA pregnancy category B agents such as Tenofovir and Telbivudine are allowed through all trimesters of pregnancy and are effective for prevention of mother to child transmission. Breastfeeding for patients who receive antiviral agents can be allowed after a risk-benefit discussion with the patient and family.

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