Day: March 27, 2023

Eliminating Mother-to-Child Transmission of Viral Hepatitis B in Vietnam

Eliminating Mother-to-Child Transmission of Viral Hepatitis B in Vietnam

Co-funded with Ville de Genève. 

GEOGRAPHIC REACH  Asia/Vietnam
PARTNER PATH, in collaboration with Nghe An Province CDC  – Co-funded with the Ville de Genève.

CONTEXT

Mothers who are infected with hepatitis B virus (HBV), HIV, or syphilis can pass these viruses to their babies during pregnancy, childbirth, or while breastfeeding—called mother-to-child transmission.. Every year, more than 180,000 newborns in the Asia-Pacific region become newly infected with HBV. Vietnam is among the countries with a high prevalence of HBV worldwide (8.1%). Since 2019, the country has endorsed the World Health Organization’s global triple elimination initiative, which seeks to eliminate mother-to-child transmission (EMTCT) for HBV, HIV, and syphilis.

THE PROGRAMME   

With support from the City of Geneva and The Hepatitis Fund, PATH, in collaboration with Nghe An Center for Disease Control (CDC), deployed a decentralized, integrated, and coordinated model of combined universal screening for HBV, HIV, and syphilis in Nghe An—Vietnam’s largest province by area, with a total population of more than 3.5 million people. 

The three-year programme, launched in 2022, is currently being implemented at commune health stations, private health facilities, and district hospitals in two districts of Nghe An, where uptake of HBV, HIV, and syphilis testing among pregnant women is low.

EXPECTED RESULTS

The project will provide a hepatitis-free future to newborn babies in Nghe An, which is Vietnam’s largest province, located in the North Central Coast region of the country, with 3,547,247 people living in 21 districts. 

The project will aim to screen 90% of pregnant women receiving antenatal care, treat 80% of eligible pregnant women with Tenofovir (TDF) prophylaxis or treatment, and vaccinate up to 98% of newborns with the HBV birth dose vaccine at the project sites by the end of the project life. 

Evidence generated from implementing the triple EMTCT model in Nghe An will be used to establish a comprehensive evidence base to advocate for financing and programming toward universal access to HBV, HIV, and syphilis screening and care. This includes integrating HBV, HIV, and syphilis screening as a core part of Vietnam’s MNCH and primary health care services and ensuring its coverage in social health insurance structures.

Grant USD 327,000 for three years.

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ADVANCING TOWARDS ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION OF HEPATITIS B IN RWANDA


GEOGRAPHIC REACH: Rwanda
PARTNER: Clinton Health Access Initiative (CHAI).  The grant is co-funded by The Hepatitis Fund and the Canton and Republic of Geneva.

AIM    

The project aims to scale hepatitis B (HBV) screening, diagnosis, and antiviral treatment among pregnant women and demonstrate that the implementation of a timely targeted hepatitis B birth-dose vaccine can prevent mother-to-child transmission (PMTCT) of hepatitis B.

CONTEXT

In Rwanda, roughly 10,000 newborns are at risk of being exposed to hepatitis B at birth every year. Transmission risk can be decreased to almost 0% through antenatal HBV screening, a combination approach using antiviral treatment in pregnant women and HBV vaccination for infants. However, service gaps and implementation challenges to delivering prevention of MTCT (PMTCT) services exist at antenatal clinics, and they must be addressed to halt the transmission of HBV between mothers and their newborns.

Rwanda has high-performing antenatal care (ANC) platform. Around 93% of Rwanda’s 350,000 pregnant women per year attend ANC facilities for delivery. Despite this, recent data indicates that only 20% of pregnant women are currently screened for HBV during pregnancy.

Rwanda has achieved 96% HBV vaccination coverage by age 5 for children and has successfully rolled out routine HBV vaccination in adults, but HepB-BD given within 24 hours of birth, a key intervention to eliminate mother-to-child transmission, has yet to be introduced.

To advance HBV eMTCT, Rwanda will build upon existing health system infrastructure established for HCV elimination (human resources, diagnostics and treatment platforms, capacity building and procurement systems) established for HCV elimination, a strong vaccination program and a strong ANC platform to advance the elimination of HBV MTCT. 

ACTION

CHAI will work with the Rwandan government to address critical barriers to scale HBV screening, diagnosis, and antiviral treatment among pregnant women and demonstrate implementation of timely targeted HepB-BD. Specifically, CHAI will support the Rwandan Government to build upon the backbone of its HIV and HCV programmes to:

  • assess and develop strategies to address HBV PMTCT service implementation challenges in Rwanda;
  • increase uptake, availability and quality of HBV PMTCT services among pregnant women;
  • implement a demonstration project for targeted HepB-BD for infants of high-risk mothers;
  • generate evidence to inform a sustainability plan for HBV services for pregnant women in Rwanda, and inform policies in other AFRO countries.

EXPECTED RESULTS 

  • ≥90% of pregnant women presenting at antenatal care receive HBsAg screening  
  • ≥90% of pregnant women with high viral load receive antiviral treatment   
  • ≥90% of infants of high-risk mothers receive targeted timely HepB-BD 
  • ≥90% of all newborns receive a complete HBV vaccine schedule (HepB3 vaccine) 

CATALYTIC IMPACT

During the project period, the successful demonstration of HBV BD among newborns of mothers who have high HBV VL levels will be used to advocate for increased government funding to scale HBV BD to all newborns. The implementation of this demonstration project will inform future introduction strategies, generate and leverage evidence to inform the sustainability plan of services in Rwanda and inform policies in AFRO countries. 

Read about our other grants.