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.
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.
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.
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.
- ≥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)
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.