Date Published: July 21, 2017
Publisher: Public Library of Science
Author(s): Nafiisah Chotun, Wolfgang Preiser, Christoffel Johannes van Rensburg, Pedro Fernandez, Gerhard Barnard Theron, Dieter Glebe, Monique Ingrid Andersson, Ravi Jhaveri.
Elimination of HIV and syphilis mother-to-child transmission (MTCT) has received much attention but little consideration has been given to the possibility of elimination of HBV MTCT. In sub-Saharan Africa, HBV vertical transmission continues to be reported and it remains an important public health problem. This study aimed to assess the feasibility of screening pregnant women for HBV using a point-of-care (POC) test and implementing interventions to prevent HBV MTCT.
In this observational prospective cohort study, HIV-uninfected pregnant women who consented to testing were screened for HBV using a rapid POC test for HBsAg. Positive results were laboratory-confirmed and tested for HBV DNA and serological markers. Women with viral loads ≥ 20 000 IU/ml received tenofovir (TDF) treatment and all infants received birth-dose HBV vaccine. Two blood samples collected six months apart from HBV-exposed infants within their first year of life were tested for HBV DNA.
Of 144 women who were approached, 134 consented to participating (93% acceptance rate of HBV POC test). Six women tested positive for HBsAg (4.5%; 95% CI 0.99%–8.01%), all confirmed by laboratory testing. Two mothers, M1 and M4, were treated with TDF during their third trimester of pregnancy. Six HBV-exposed infants received the HBV vaccine within 24 hours of birth, of whom two were lost to follow-up and four (including the two born to M1 and M4) had undetectable levels of HBV DNA when tested at the two time points.
We found that HBV screening using POC testing fulfilled the criteria considered necessary for implementation. It has acceptable performance, is inexpensive, reliable, and was well accepted by the study participants. Screening pregnant women as part of the HBV MTCT prevention strategy is therefore feasible in a South African clinical setting.
Hepatitis B virus (HBV) infection causes substantial, and largely unappreciated, morbidity and mortality. Globally, it is estimated that 248 million people have an active HBV infection  and that every year 686 000 people die as a direct consequence of this infection . This is despite the availability of a safe and effective vaccine and potent antiviral therapy.
HBV is an important public health problem that requires more attention. We have shown that screening pregnant women for HBV is feasible in a South African clinical setting. Screening for HBV infection fulfils the Wilson-Jungner criteria. The POC test is reliable, inexpensive, and was readily accepted by the participants of this study. This study also provided some evidence that screening pregnant women, providing antivirals to treat those with high HB viral loads, and providing HBV birth-dose vaccine to HBV-exposed infants can be implemented in South Africa. This data supports the call to South African politicians and policymakers to establish clear guidance on the prevention of HBV MTCT. It is only this which will reduce the perpetual cycle of infection in African communities and enable us to reduce, indeed eliminate this eminently preventable infection.