Abstract
Objective To construct the regional elimination of mother-to-child transmission (EMTCT) clinic (E-clinic) service system and evaluate its effect. Methods Since November 2018, the E-clinic service system has been established in the obstetric clinic of 18 maternal and child health (MCH) providers in Baoan District, Shenzhen, China, forming a regional service system. In E-clinics obstetricians take care of pregnant women with hepatitis B virus (HBV) infection for complete perinatal services and infectious disease management. Before and after the implementation of the E-clinic service system, the changes of HBV screening rate among pregnant women, HBV infected mothers DNA detection rate, mothers with high viral load (> 2 × 106 IU/mL) antiviral therapy (ART) rate and HBV MTCT rate were analyzed. Results From July 2018 to March 2020, there were 162,036 registered pregnant women and 7,358 HBV infected mothers in Baoan District, Shenzhen, including 1,179 mothers with high viral load. The HBV screening rate among pregnant women, HBV infected mothers follow up rate, HBV infected mothers DNA detection rate and ART rate were 97.6% (124,311/127,379), 99.0% (5,742/5,801), 82.8% (4,805/5,801) and 70% (687/982) respectively, which were higher than 95.9% (33,247/34,657), 93.1% (1,449/1,557), 49.3% (767/ 1,557) and 21.3% (42/197) before the implementation of the E-clinic service system. The differences were statistically significant (P 0.05). Conclusions The E-clinic service system of Baoan District in Shenzhen integrates antenatal care (ANC) and ART, improves the management of HBV infection during pregnancy, further reduces the HBV MTCT, and provides experience for other regions to manage infectious diseases during pregnancy.
Highlights
Hepatitis B remains as the main public health threat in the world, the World Health Organization (WHO) estimated that in 2015, 257 million individuals were living with hepatitis B virus (HBV) infection globally, 887,000 people died due to complications of HBV infection [1]
In 2017, we have developed a Management Algorithm for Interrupting mother-to-child transmission (MTCT) of HBV, it recommended that among pregnant women with HBV DNA>2 × 106 IU/mL, antiviral therapy (ART) with either tenofovir disoproxil fumarate (TDF) or telbivudine (LdT) should be administered [8]
From July 2018 to March 2020, there were 162,036 women had their pregnancy registration in Baoan District, Shenzhen, and 7,358 cases of HBV infected mothers, among which 1,179 cases were of high viral load. the HBV screening rate among pregnant women, HBV infected mothers follow up rate, HBV infected mothers DNA detection rate and ART rate were 97.6% (124311/127379), 99.0% (5742/5801), 82.8% (4805/5801) and 70% (687/982), respectively, all of them counterparts were higher than 95.9% (33247/34657), 93.1% (1449/1557), 49.3% (767/1557) and 21.3% (42/197) before the implementation of the E-clinic service system
Summary
Hepatitis B remains as the main public health threat in the world, the World Health Organization (WHO) estimated that in 2015, 257 million individuals were living with HBV infection globally, 887,000 people died due to complications of HBV infection [1]. Pregnant women with HBV infection needed referral across different health facilities and reduced the adherence of ART. The lack of unified management of HBV infected pregnant women in health facilities makes the continuous and integrity of treatment difficulty. In 2017, we have developed a Management Algorithm for Interrupting MTCT of HBV, it recommended that among pregnant women with HBV DNA>2 × 106 IU/mL, ART with either tenofovir disoproxil fumarate (TDF) or telbivudine (LdT) should be administered [8]. For further reducing the risk of HBV MTCT, the China’s Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B virus (2019 edition) [9] recommended that for pregnant women with HBV DNA>2 × 105 IU/mL, TDF and LdT could be administered during pregnancy
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