Elimination Of Mother-to-child Transmission Research Articles

Strengthening Laboratory Systems for Ensuring Accurate Diagnoses in Mother-to-Child Transmission (MTCT) Prevention Programs in Uganda: A Narrative Review

Mother-to-child transmission (MTCT) of HIV remains a significant public health challenge in Uganda, necessitating a focused examination of the state of laboratory systems to ensure accurate diagnoses and effective prevention. The aim of this narrative review is to assess the current state of laboratory systems supporting Mother-to-Child Transmission (MTCT) prevention programs in Uganda, identify challenges hindering accurate diagnoses, and propose strategies for strengthening these systems to enhance the effectiveness of MTCT prevention efforts. This narrative review explores the current landscape of laboratory infrastructure in Uganda, addressing challenges unique to the country and proposing strategies for improvement. The discussion encompasses the integration of molecular testing, the role of point-of-care diagnostics, the implementation of quality assurance programs, and capacity-building initiatives for laboratory personnel. Additionally, technological innovations and their applicability in the Ugandan context are explored, alongside the crucial aspect of integrating laboratory services into antenatal care. Drawing on global lessons, the review provides tailored recommendations for Uganda, spanning policy considerations, funding mechanisms, infrastructure enhancements, and workforce development. Looking towards the future, the review outlines potential collaborations, technological advancements, and strategic investments that can further fortify laboratory systems, ultimately contributing to the elimination of MTCT in Uganda.

Knowledge of mother-to-child transmission of HIV among women living with HIV in Malawi.

To reduce the incidence of mother-to-child transmission (MTCT) of HIV in Malawi, interventions have been created for women to be informed about the MTCT of HIV and for women living with HIV to be entered into the HIV care cascade to ensure safer deliveries. Our study aimed to examine the effectiveness of these strategies by exploring the determinants of adequate knowledge of MTCT of HIV among women living with HIV in Malawi. We used the 2015-16 Malawi Demographic and Health Survey data and applied logistics regression analysis to explore the determinants of adequate knowledge of MTCT of HIV among women living with HIV. Our findings estimated that 75% of women living with HIV possessed adequate knowledge of MTCT of HIV. We also found that compared to those with no formal education, women with primary education (OR = 1.88, 95% CI = 1.04, 3.41) and secondary education or higher (OR = 2.61, 95% CI = 1.21, 5.62) were more likely to have adequate knowledge of MTCT of HIV. Furthermore, women who were resident in rural areas (OR = 2.97, 95% CI = 1.58, 5.57), were more likely to have adequate knowledge of MTCT of HIV relative to those in urban areas. Finally, women who had adequate HIV knowledge (OR = 1.85, 95% CI = 1.19, 2.89) and those who rejected the endorsement of HIV stigma and discrimination (OR = 2.30, 95% CI = 1.39, 3.81) were more likely to have adequate knowledge about the MTCT of HIV. Based on our findings, there is an urgent need to offer women living with HIV in Malawi the opportunity to increase their knowledge of MTCT of HIV if the country is to make progress towards the elimination of MTCT of HIV as part of the overall strategy to contain new HIV infections in the country.

The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors.

Mother-to-child transmission of syphilis remains high especially in the WHO AFRO region with a prevalence of 1.62%, resulting in a congenital syphilis rate of 1,119 per 100,000 live births. Elimination efforts can be supported by an understanding of the spatial and temporal changes in disease over time, which can identify priority areas for targeted interventions aimed at reducing transmission. We collated routine surveillance data from health facilities and covariate data from demographic and health surveys conducted in Malawi between 2014 and 2022. We fitted a Bayesian hierarchical mixed model with spatial and temporally structured random effects to model the district-level monthly counts of maternal syphilis notifications as a function of individual- and district-level predictors. We then generated district-level spatiotemporally explicit risk profiles to estimate the effect of individual- and district-level covariates on maternal syphilis notifications and to identify hotspot areas. Overall, the national prevalence of maternal syphilis increased from 0.28% (95% CI: 0.27-0.29%) in 2014 to peaking in 2021 at 1.92% (95% CI: 1.89-1.96%). Between 2020 and 2022, there was a decline in prevalence, with the most significant decline seen in Zomba District (1.40, 95% CI: 1.12-1.66%). In regression models, a one percentage point increase in district-level antenatal HIV prevalence was associated with increased maternal syphilis (prevalence ratio [PR]: 1.15, 95% credible interval [CrI]: 1.10-1.21). There was also an increased prevalence of maternal syphilis associated with an increased district-level mean number of sex partners (PR: 1.05, 95% CrI: 0.80-1.37). The number of districts with a high prevalence of maternal syphilis also increased between 2014 and 2022, especially in the southern region, where most had a high probability (approaching 100%) of having high maternal syphilis (defined as relative risk >1 compared to the standard population of women aged 15-49 years) in 2022. Maternal syphilis prevalence in Malawi shows an increasing upward trend, with an estimated six times relative increase between 2014 and 2022 (0.28% to 1.73%) and strong associations with higher district-level HIV prevalence. Controlling syphilis depends on reaching vulnerable populations at the sub-national level, which may be disproportionately affected. Our findings support the move to integrate the elimination of mother-to-child transmission (EMTCT) of syphilis programs with existing prevention of mother-to-child transmission (PMTCT) of HIV programs.

Eliminating mother-to-child transmission of hepatitis B virus: practice and progress in Baoan, a national pilot district of China

BackgroundWhile mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains a significant challenge in China, research investigating the effectiveness of the September 2017 pilot program to eliminate MTCT of HIV, syphilis, and HBV is limited. Baoan district, which has a higher-than-average rate of hepatitis B infection among pregnant women and strong support from the government, was one of six national pilot districts selected for the program. Therefore, this study aims to assess the progress and implementation of the elimination of MTCT of HBV in Baoan district over a period of 5 years.MethodsData was collected from the national information system for the prevention of MTCT, registration forms, and follow-up forms of pregnant women and their live births from 2018 to 2022. Joinpoint models were used to analyze changing trends over time, calculating annual percentage change (APC) and the corresponding 95% confidence interval (95%CI). Multivariate logistic regression models were used to analyze risk factors for HBV MTCT.ResultsFrom 2018 to 2022, the coverage of HBV screening during pregnancy increased from 98.29 to 99.55% (APC = 0.30, P = 0.012). The coverage of HBV early screening within 13 gestational weeks increased from 40.76 to 86.42% (APC = 18.88, P = 0.033). The prevalence of maternal HBV infection declined by an APC of − 3.50 (95% CI -6.28 ~ − 0.63). The coverage of antiviral therapy among high-risk pregnant women increased from 63.59 to 90.04% (APC = 11.90, P = 0.031). Coverage for timely administration of hepatitis B immunoglobulin, hepatitis B birth dose vaccine, and three-dose hepatitis B vaccination remained consistently above 97.50%. The coverage of post-vaccination serological testing (PVST) in high-risk infants was 56.15% (1352/2408), and the MTCT rate of HBV was 0.18%. Mothers with high-school education or below (OR = 3.76, 95% CI 1.04 ~ 13.60, P = 0.04) and hepatitis B e antigen (HBeAg) positivity (OR = 18.89, 95% CI 1.98 ~ 18.50, P = 0.01) had increased MTCT risk.ConclusionsThe implementation of comprehensive prevention strategies in Baoan district, including screening, treatment, and immunoprophylaxis, has proven effective in maintaining the MTCT of HBV at an extremely low level. However, it remains crucial to raise public awareness, specifically on the importance of improving the coverage of PVST for infants exposed to HBV.

Evaluation of Process Indicators and Challenges of the Elimination of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B in Bali Province, Indonesia (2019-2022): A Mixed Methods Study.

This study was conducted to describe the prevalence of and evaluate the processes and challenges in implementing the elimination of HIV, syphilis, and hepatitis B transmission from mother to child in Bali Province, Indonesia. The research method used is a descriptive approach using indicators and a set of processes by the WHO, quantitative methods using descriptive analysis, and qualitative methods using phenomenological paradigms through in-depth interviews and FGD with healthcare professionals involved in the elimination of mother-to-child transmission (EMTCT) program. The indicators that have successfully met the target for 4 years are antiretroviral therapy (ART) coverage in Badung District (≥95%) and ANC coverage (at least one visit) in Buleleng District (≥95%). The study found low prevalence rates of HIV, syphilis, and hepatitis B among pregnant women in the three districts. There are some indicators that show improvement from 2019 to 2022, namely, syphilis (60.44% to 86.98%) and hepatitis B (29.03% to 95.35%) screening coverage showed improvements, with increasing screening rates observed in Buleleng District. However, adequate treatment coverage for pregnant women with syphilis decreased in Denpasar City in 2022 compared to 2019 (100% to 71.28%). Despite data on hepatitis B treatment being unavailable, hepatitis B vaccination coverage exceeded the WHO target in all three districts. The utilization of the information system is not yet optimal, and there is a lack of ability to track cases. Furthermore, there is insufficient involvement of the private sector, particularly in screening, and a lack of standardized procedures in the management of referrals for pregnant women with hepatitis B. The prevalence of HIV, syphilis, and hepatitis B among pregnant women has consistently remained below the Ministry of Health's target for four years. Despite this, there are a lot of targets, and the indicator EMTCT process has yet to reach the WHO target. The challenges for each district in reaching the WHO target include providing syphilis and hepatitis B reagents and benzatine penicillin; increasing private sector involvement; and strengthening information systems, policies, and guidelines for the management of hepatitis B among pregnant women in line with WHO recommendations to achieve EMTCT.

Perspectives and challenges for mother-to-child transmission of HIV, hepatitis B, and syphilis in Brazil.

Eliminating mother-to-child transmission (MTCT) of HIV, hepatitis B, and syphilis is a challenge in Brazil. Many policies have been implemented since 1986, but important gaps remain. This study aimed to describe the trends of MTCT in Brazil and evaluate the gaps and perspectives in this scenario. This is a descriptive study conducted with secondary data publicly available in the information systems of the Brazilian Ministry of Health regarding data on HIV, syphilis, and hepatitis B in pregnant women and children from 2011 to 2021. HIV and hepatitis B have had constant rates over the years in pregnant women, with the detection rates around 2.5/1,000 live birth (LB) and 0.5/1.000LB, respectively. The same did not happen with syphilis, which has shown an increasing line in the last decade. In 2011, the detection rate of syphilis in pregnancy was 4.7/1,000LB, and in 2021 it reached 27.1/1,000LB. Regarding the trends in children, an important decrease was observed in HIV/AIDS (incidence rate from 0.18/1,000 in 2011 to 0.04/1,000 in 2021) and Hepatitis B (incidence rate from 0.9/1,000LB in 2011 to 0.5/1,000LB in 2021). For congenital syphilis, there is a continuous increase, being 3.3/1,000LB in 2011 and 9.9/1,000LB in 2021. Data from the HIV clinical monitoring showed that antiretroviral treatment coverage among pregnant women identified increased slightly between 2011 and 2021, in Brazil, from 92.3% to 94.3%. For syphilis, 82.5% of pregnant women were treated with benzathine penicillin, and 88.7% in 2011. The historical series of hepatitis B vaccination coverage in children has decreased over the years; it was 96% in 2013 and 76% in 2021. These data show many gaps and some perspectives in the MTCT program in Brazil. The country is close to reaching MTCT HIV elimination, but there are many challenges regarding HBV and syphilis. These data can be used to organize the strategies to improve the Brazilian response to MTCT elimination of HIV, hepatitis B, and syphilis.

A Case Control Study to Assess Factors Associated with HIV Mother to Child Transmission in Kenya

Background: With the proposal that people with undetectable serum viral loads of HIV cannot transmit, there is a large gap, either due to viral discordance or transcytosis, that would be explaining the persistent 4 to 7 percent vertical transmission of HIV to infants by Kenyan mothers. Therefore, we looked for factors that predispose mothers with HIV to transmit the disease to their children so that policy can be generated for their screening to be conducted if they fit the specified criteria that identifies them as a high-risk group. Methods: Through access to the National Database providing HIV treatment services country wide, we looked for the presence of the available factors from MTCT cases and assessed their association with increased risk of vertical transmission. The factors assessed were mother’s blood plasma viral load (BPVL), geographic location of the mother and child (associated with specific higher and lower socioeconomic status), gender of the baby being born, time age after birth with confirmation of Mother to Child Transmission (MTCT), method of feeding chosen by mothers, age of the mothers, and the regimen of Highly Active Anti Retro Viral treatment (HAART) that the mother and child had been given. Results: Mixed breast feeding posed a much higher risk, mothers of a younger age posed a higher risk, residents of some areas were at higher risks, of note the town of Lamu in Kenya. The at birth stat administration of Niverapin with Zidovudin (NVP+AZT) to the baby was very effective against the transmission, in comparison to any of the other interventions, and having an UD BPVL led to a six-fold reduction the risk of MTCT. Conclusion: There are factors that are associated with a higher risk of vertical transmission from pregnant and lactating UD BPVL mothers which warrant implementation of more stringent policy in their case to achieve Elimination of MTCT(EMTCT) in Kenya. Other factors that were not in the available records and the ones found to have an impact need to be investigated with more accuracy through a prospective study.

Preventing mother-to-child transmission of human immunodeficiency virus (HIV), syphilis and hepatitis B: a secondary hospital approach in North Bali, Indonesia

Background Mother-to-child transmission (MTCT) of human immune virus (HIV), syphilis, and hepatitis B can lead to significant health burdens and even mortality in children. This study aimed to evaluate the effectiveness of triple elimination of MTCT in a secondary hospital in Buleleng, North Bali Method: This study conducted a retrospective review of 345 pregnancy case in Buleleng General Hospital from January to December 2022 Result: In this study, 98.5% of the 345 pregnant women seeking antenatal care were tested for HIV, syphilis, and hepatitis B. Among the tested patients, 100%, 99.7%, and 98.8% were tested for HIV and hepatitis B, HIV and syphilis, and syphilis and hepatitis B, respectively. The prevalence of HIV, syphilis, and hepatitis B was 1.4%, 2.1%, and 4.3 %, respectively. Antiretroviral therapy was administered to 80 % of HIV-positive patients, and 71.4 % of syphilis patients received benzathine penicillin G. Only 6.6% of hepatitis B patients received hepatitis B virus deoxyribonucleic acid (HBV DNA) & hepatitis B envelope antigen (HBeAg) examination followed by Lamivudine administration. Conclusion: Early detection of HIV, syphilis, and hepatitis B in pregnant women is important for preventing MTCT. Coverage of triple elimination screening is in accordance with WHO targets, but further management of hepatitis B needs to be improved

Achieving HIV Epidemic Control and Improving Maternal Healthcare Services with Community-Based HIV Service Delivery in Zambia: Mixed-Methods Assessment of the SMACHT Project.

Novel community-based approaches are needed to achieve and sustain HIV epidemic control in Zambia. Under the Stop Mother and Child HIV Transmission (SMACHT) project, the Community HIV Epidemic Control (CHEC) differentiated service delivery model used community health workers to support HIV testing, ART linkage, viral suppression, and prevention of mother-to-child transmission (MTCT). A multi-methods assessment included programmatic data analysis from April 2015 to September 2020, and qualitative interviews from February to March 2020. CHEC provided HIV testing services to 1,379,387 clients; 46,138 were newly identified as HIV-positive (3.3% yield), with 41,366 (90%) linked to ART. By 2020, 91% (60,694/66,841) of clients on ART were virally suppressed. Qualitatively, healthcare workers and clients benefitted from CHEC, with provision of confidential services, health facility decongestion, and increased HIV care uptake and retention. Community-based models can increase uptake of HIV testing and linkage to care, and help achieve epidemic control and elimination of MTCT.

Incidence of HIV Infection among HIV-Exposed Iinfants at Gondar University Hospital from 2019-2021: A Prospective Cohort Study.

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is decreasing worldwide; however, achieving the MTCT elimination target of 2% by 2020 and 0% by 2030 is challenging in resource-limited countries. Preventing mother-to-child transmission (PMTCT) is a key strategy in eliminating new pediatric human immunodeficiency virus (HIV) infection Strengthening PMTCT program is one of the key mechanisms for the elimination of Pediatric HIV infection and improving maternal and newborn survival. Assessing the incidence of HIV infection among HIV exposed infants is critical to devise an important preventive strategy which was the main objective of this study. A prospective Cohort study was conducted at Gondar University Comprehensive Specialized Hospital, PMTCT clinic to assess the incidence of HIV infection among HIV exposed infants from 2019-2021. The overall incidence of HIV infection among HIV exposed infants was 3.6%. HIV infection rate was significantly increased among HIV exposed infants coming out of Gondar, Infants with developmental failure and Infants with Unknown fathers' HIV status compared to their counterpart. The incidence of HIV infection among 307 HIV-exposed infants was 3.6% which is higher than the expected standard. The lost to follow up rate was also significant (9.4%). These finding showed that strengthening the PMCT service is mandatory.

Congenital Syphilis: a Review of Global Epidemiology.

In 2007, the World Health Organization (WHO) launched a global health initiative for the elimination of mother-to-child transmission (MTCT) of syphilis. This condition is highly preventable through antenatal identification of syphilis infection and treatment with penicillin during pregnancy. This review summarizes the global status of MTCT of syphilis and concludes that this condition remains a significant issue worldwide. There are large variations in case rates by region, with the highest numbers of cases in the African and Eastern Mediterranean regions, where there are also the least data available. There are also pockets of high-incidence areas within the other regions. Although the general trend is of decreasing rates over time, there are concerning indications of consistently increasing congenital syphilis cases in some areas, particularly in areas which have previously had very low case numbers. A concerted effort will be required to achieve the 2007 WHO goal of worldwide elimination of MTCT of syphilis in the near future.

Uptake of perinatal immunoprophylaxis for infants born to women with a record of hepatitis B in Victoria (2009-2017).

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains one of the leading causes of transmission worldwide. An estimated 90% of infants who are exposed to HBV and do not receive appropriate post exposure immunoprophylaxis will go on to develop chronic hepatitis B (CHB). In Australia, universal birth dose vaccination was adopted in 2000 and universal antenatal screening for hepatitis B was introduced in the 1990s, however up to 10% of women may have missed screening. There is no coordinated care or data collection that systematically reports the access to interventions to prevent mother-to-child transmission (PMTCT) for women with CHB. Therefore, the incidence rate of MTCT is unknown. We conducted retrospective data linkage of perinatal records, public health notification and hospital admission data to identify women with a record of HBV infection who had given birth to a live infant(s) in Victoria between 2009 and 2017. We assessed uptake of birth dose vaccination and hepatitis B immunoglobulin (HBIG) and explored factors associated with administration of birth dose recorded as administered within 7days. Among 690,052 live births, 6118 births (0.90%) were linked to 4196 women with a record of HBV infection. 89.4% of all Victorian infants (n=616,879), and 96.8% of infants linked to women with a positive record of CHB (n=5,925) received birth dose within 7days. Infants born in private hospitals had reduced odds of receiving birth dose when compared to public hospitals births (Victorian population, aOR=0.67, 95%CI=0.66, 0.69; CHB linked records aOR=0.17, 95%CI=0.11, 0.25). Of the 6118 infants linked to a positive maternal record of CHB, discrepant recording of maternal CHB status between the three datasets was identified in 72.4% of records and HBIG administration was recorded for only 2.3% of births. An approach that involves coordinated care and integrates data collection for women with CHB and their infants is required to support the elimination of MTCT of hepatitis B in Victoria.

Towards the elimination of mother to child transmission of syphilis 2015–2020: practice and progress in Zhejiang province, eastern China

ObjectivesTo estimate the progress towards elimination of mother-to-child transmission (EMTCT) of syphilis in Zhejiang province.MethodsData were obtained from Zhejiang provincial EMTCT network. Childbearing women infected with syphilis during 2015–2020 were recruited. Joinpoint mode was used to analyze changing trends in syphilis screening, treatment and adverse pregnancy outcomes (APOs). Changing trends were presented as the annual percentage of change (APC). Multivariate logistic regression mode was used to analyzerisk factors of APOs.ResultsOf 3,658,266 participants, an average maternal syphilis incidence was 0.38%. From 2015 to 2020, the coverage of syphilis screening in pregnancy (96.31% to 99.24%; P < 0.001) and coverage of antenatal health care (ANC) within 13 gestational weeks (55.27% to 77.82%; P = 0.002) were increased.The coverage of maternal syphilis treatment(88.30% to 98.25%; P = 0.001) and adequate treatment (66.92% to 83.37%; P = 0.001) were also increased. Over the years, the APC was -19.30% (95%CI:-24.33 ~ -13.92, P = 0.001) in perinatal death,-26.55% in congenital syphilis(95%CI:-38.75 ~ -11.92, P = 0.009), and -14.67% in other neonatal complications (95%CI:-23.96 ~ -4.24, P = 0.019).In 2020, 11.58% of women had APOs. The rate of syphilis infection during pregnancy increased among women aged (< 20 years) or (≥ 35 years), multiparous, and with pregnancy complications (all P < 0.05).APOs risk increased in women with higher maternal RPR/TRUST titers while it decreased in women who had (adequate) therapy, early ANC, and aged in 21–34 years (all P < 0.001).ConclusionsDespite steady progress towards the goal of EMTCT in implementing universal screening and treatment, syphilis continuously affects a large number of pregnant women. Increasing vulnerable women, small proportions of inadequately treated and delay in early ANC should be noticed.

Status Report on the Elimination of Mother-to-Child Transmission (EMCT) of HIV at the Pikine National Hospital Center (CHNP), Dakar/Senegal

Status Report on the Elimination of Mother-to-Child Transmission (EMCT) of HIV at the Pikine National Hospital Center (CHNP), Dakar/Senegal

ELIMINATION OF MTCT OF HIV IN INDIA BY 2030: CURRENT STATUS AND THE WAY AHEAD

Background:Considering the global public health priority of eliminating Mother-to-child transmission (MTCT) of HIV, World Health Organization (WHO) started the initiative of Global Plan Towards Eliminating New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive. Owing to those efforts, the number of children aged between 0-14 years acquiring HIV has decreased since 2011, but not rapidly enough. India is one among the 23 focus countries and while Cuba, Maldives, Thailand and recently Sri Lanka have successfully eliminated MTCT of HIV, India is lagging behind in this ambitious goal despite sustained efforts. Methods: A systematic review of recent literature on MTCT of HIV, current global and Indian status regarding MTCT and the successful approach and methods of countries which were certified by WHO as to have eliminated MTCT of HIV was performed and analysed. Results: As MTCT of HIV has three distinct points – during pregnancy, during delivery and during breastfeeding, the approaches to prevent MTCT also focus on these points chiefly. However, educating the adolescent girl and women of child bearing age would serve as the primordial prevention which also enormously reduces the burden among the three points mentioned above. Awareness also pave a way for volunteering in testing for HIV before planning for pregnancy and regularly checking if the mother found to be HIV positive, keeping the viral load under the desired level in addition to adherence to ART wherever necessary. Discussion: Focusing in all areas where there is possibility of MTCT, Promoting antiretroviral therapy adherence to mothers and children, Involving community level workers, Improved case detection and Strengthening of health system are the measures to be followed in order to achieve elimination of MTCT of HIV in India Conclusion: In the developing countries like India early diagnosis, awareness and the community participation and in collaboration with NGOs can help to achieve the target of elimination of MTCT of HIV.

New progress towards elimination of mother-to-child transmission of hepatitis B virus in China.

BackgroundWe conducted an evaluation on the potential data resources for the elimination of hepatitis B virus (HBV) mother-to-child transmission in China, so as to provide reference for WHO and other countries in the validation of HBV elimination of mother-to-child transmission (EMTCT) in a real-world large country setting.MethodsWe used the indicators set out in WHO Interim guidance for country validation of viral hepatitis elimination as the benchmark to evaluate the availability of data and progress against indicators for the elimination validation in China. We used descriptive analysis to illustrate the status of all indicators and parameters.ResultsAccording to the indicators which are recommended by WHO for HBV EMTCT validation, the national data in China are attainable, though not for HBV DNA testing for the HBsAg-positive mothers and their subsequent management. The remaining challenges for China are to consider how the national serosurvey might be conducted in future in the context of low HBV prevalence among children under 5 years; to collect systematically the programmatic impact data; to strengthen multi-sectoral collaboration among immunization, maternal and child health, hospital services, as well as other stakeholders.ConclusionThe available data on HBV EMTCT are sufficient to support the validation of the elimination of HBV mother–to-child transmission in China.

Progress Toward the Elimination of Mother-to-Child Transmission of Hepatitis B Virus - Worldwide, 2016-2021.

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) often results in chronic HBV infection, the leading cause of cirrhosis and liver cancer (1). If not vaccinated, nine in 10 children infected at birth will become chronically infected. Globally, an estimated 6.4 million (range=4.4-10.8 million) children aged ≤5 years are living with chronic HBV infection (2). In 2016, the World Health Assembly endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, including the elimination of MTCT of HBV (3). Elimination of MTCT of HBV can be validated by demonstrating ≤0.1% prevalence of HBV surface antigen (HBsAg) among children aged ≤5 years, as well as ≥90% coverage with hepatitis B birth dose (HepB-BD) and 3 doses of hepatitis B vaccine (HepB3) (4,5). This report describes global progress toward elimination of MTCT of HBV during 2016-2021. By December 2020, 190 (98%) of 194 World Health Organization (WHO) member states* had introduced universal infant vaccination with hepatitis B vaccine (HepB), and 110 (57%) countries provided HepB-BD to all newborns. During 2016-2020, global HepB3 coverage remained between 82% and 85%, whereas HepB-BD coverage increased from 37% to 43%. In 2020, among the 99 countries reporting both HepB3 and HepB-BD coverage, 41 (41%) achieved ≥90% coverage with both. By December 2021, serosurveys documented ≤0.1% HBsAg prevalence among children in 11 countries. Accelerating HepB-BD introduction, increasing HepB3 coverage, and monitoring programmatic and impact indicators are essential for elimination of MTCT of HBV.

Pediatric AIDS-Therapeutic Successes Built on a Foundation of Pediatric Clinical Pharmacology with Pharmacokinetic-Pharmacodynamic Modeling.

Pediatric AIDS-Therapeutic Successes Built on a Foundation of Pediatric Clinical Pharmacology with Pharmacokinetic-Pharmacodynamic Modeling.

Dealing with tests and treatments for HIV, syphilis, and hepatitis B infection to prevent mother-to-child transmission (MTCT) from a tertiary hospital in Indonesia

Background: Mother-to-child transmission (MTCT) of Human Immunodeficiency Virus (HIV), syphilis, and Hepatitis B can cause a health burden and lead to morbidity and mortality in children. An attempt to eliminate the transmission has been made worldwide. This study aimed to evaluate the triple elimination of MTCT for HIV, syphilis, and hepatitis B in a tertiary hospital in Indonesia. Methods: We evaluated 690 medical records of new pregnant women seeking antenatal care (ANC) in a tertiary hospital in the east part of Indonesia from January to December 2018. Results: HIV, syphilis, and hepatitis B testing were performed on 97 patients (14.1%). HIV and hepatitis B, HIV and syphilis, and syphilis and hepatitis B testing were performed on 149 (21.6%), 6 (0.9%), and 6 (0.9%) patients, respectively. The prevalence of HIV, syphilis and hepatitis B was 4.2%, 0.4%, and 3.8%, respectively. HIV treatment by administering antiretroviral therapy (ART) was done in 86.2% of patients. Injection of benzathine penicillin G as the treatment of syphilis was done in 66.7% of syphilis patients. HBV DNA examination followed by tenofovir administration was done in 3.8% of hepatitis B patients. Conclusion: The testing rate of HIV, syphilis, and hepatitis B in pregnant women in a tertiary hospital in the east part of Indonesia in 2018 (14.1%) was below the target set by World Health Organization (≥ 95%). Increasing access to antenatal screening as early detection is the key to preventing mother-to-child transmission (MTCT).

Population-level risk factors for vertical transmission of HIV in the national prevention of mother-to-child transmission programme in South Africa: An ecological analysis

Background. Although South Africa has an overall mother-to-child transmission (MTCT) of HIV rate &lt;5%, case rates remain high. Objectives. To identify population-level predictors of MTCT to inform targeted interventions to further reduce paediatric HIV incidence. Methods. The study was an ecological analysis of routine laboratory HIV-related test data from a synthetic cohort of women of reproductive age living with HIV (WRLHIV), identified from the National Health Laboratory Service’s Corporate Data Warehouse between 2016 and 2017. Criteria based on syphilis screening and timing of HIV-related tests were used to identify pregnant and non-pregnant WRLHIV. Pregnant WRLHIV were followed from cohort entry at the first antenatal care (fANC) visit, through delivery to exit at the latest viral load (VL) or 15 months post delivery. Follow-up for non-pregnant WRLHIV started at cohort entry on 1 January 2016 to exit at the latest VL or 31 December 2018. HIV VL tests performed at cohort entry, delivery and cohort exit described viraemia (VL ≥50 copies/mL) at subdistrict level. A negative binomial regression model determined the association between MTCT cases and the number of viraemic WRLHIV at different time points, controlling for number of WRLHIV aged &lt;25 years at cohort entry and other routine HIV-related indicators at subdistrict level. Results. Of 3 386 507 WRLHIV identified, 178 319 (5.3%) met criteria for pregnancy. Median (interquartile range (IQR)) proportions of women with fANC booking &lt;20 weeks’ gestation, maternal HIV seroprevalence during antenatal care (ANC) and antiretroviral therapy (ART) coverage during ANC were 68.2% (62.9 - 72.8), 31.5% (23.4 - 35.7) and 94.8% (89.7 - 97.8), respectively. Viraemia was consistently higher in pregnant v. non-pregnant WRLHIV at median proportions of 42.9% (38.3 - 59.3) v. 35.0% (25.9 - 49.0) at cohort entry (p&lt;0.001) and 36.3% (25.0 - 48.4) v. 29.6% (21.0 - 42.6) at cohort exit (p&lt;0.001). In total, 4 535 children aged &lt;24 months tested HIV polymerase chain reaction-positive, representing a median subdistrict-level case rate of 1 372 (914 - 2 077) per 100 000 live births. Maternal viraemia postpartum, maternal HIV seroprevalence and ART coverage during ANC positively correlated with cases of MTCT, while higher proportions of women with fANC booking &lt;20 weeks’ gestation were associated with a decline in MTCT cases. Conclusions. Findings suggest that maternal viraemia postpartum, geographical areas with a higher burden of maternal HIV, women initiating ART late in pregnancy and/or incident maternal HIV during pregnancy are significant population-level predictors of MTCT in the national prevention of MTCT programme. Scale-up of HIV prevention services is required to lower maternal HIV prevalence, while expanded access to HIV testing will fast-track ART initiation among WRLHIV. Increased VL monitoring is critical to improve VL suppression rates for elimination of MTCT.