Plans for the Introduction - PowerPoint Presentation

Slide1

Plans for the Introduction

of

Hepatitis B Birth Dose in Mozambique

Helga Guambe

, MOH Mozambique

Background (1)

Population size 30,853,842 people

Total maternity wards 1,391Fertility rate of 5.3%1st ANC coverage 115%4th ANC coverage 58,5% Live births 1,150,089 (2020) 85% institutional deliveriesPrevalence of HIV (15-49 years) 13.2% (IMASIDA 2015)

(SISMA 2020)

Background (2)

Vaccination coverage levels for:

HBV (pentavalent; DPT/Hep B/HIB ) vaccine available since 2004 as part of the immunization schedule for all childrenVaccines given at birth (OPV0, BCG) – OPV0- 107%, BCG 124%DPT1/Hep B/HIB coverage: 117%DPT 3/Hep B/HIB coverage: 108%

(SISMA 2020)

Background (3)

Hepatitis B birth dose is not provided in the country but has been approved by the national immunization committee to be implemented in the country

However the Hep B birth dose is included in the National Plan for the Triple Elimination of Vertical Transmission (HIV, Syphilis and Hep. B)(SISMA 2020)

Background (4)

Despite limited data, prevalence of HBV in Mozambique is thought to be high

Estimated prevalence of HBsAg general population –7.2% women of reproductive age –10 % (2017 modeling report)ART naive HIV-positive –7.6% (95%CI 6.1-9.3) with 25% of all HBsAg+ having a HBV viral load (VL)> 8,617,488 IU/mL)Study conducted in a youth clinic (median age 16.6 years) in Maputo –

12.2% (95%CI 10.5%-14.0%).

Font: Public Health impact of a population based approach to HBV and HCV prevention and treatment in Mozambique

Hepatitis B Screening and Prevention Policy (1)

1. HBsAg screening of pregnant women

National policy to screen all pregnant women, in the first ante-natal visit, preferably in the 1st trimester of pregnancy2019

Hepatitis B Screening and Prevention Policy (2)

2.

Treatment guidelines for infected pregnant womenat ANC:HBV/HIV co-infected pregnant women, TDF/3TC/DTG as per national first line ARV protocolHBV mono-infected pregnant women evaluated for eligibility to start antiviral prophylaxis with TDF from 28 weeks of gestation or treatment with TDF or Entecavir (ETV) if necessary

2019

Hepatitis B Screening and Prevention Policy (3)

3. National PMTCT Triple Elimination Plan Objectives:

Integrate the birth dose of Hepatitis B into the national vaccination schedule;Start HBsAg testing at ANCs as soon as a basic package is available for prevention, diagnosis and treatment of Hepatitis B;Assess cost-effectiveness in the context of Mozambique on the use of antivirals to prevent HBV Vertical transmission;Integrate Hepatitis B indicators into M&E system

HBV PMTCT –

Chamanculo

ANC and Maternity

Chamanculo

HBV PMTCT Project

Strategy for preventing hepatitis B vertical transmission focused on use of tenofovir for pregnant women and introduction of birth-dose vaccine considering:Mozambique is a LMIC with high transmission for HBVThere are patients who need Hepatitis B treatment following WHO recommendations, and are not receiving itHepatitis B vaccine birth dose is not included in national immunization schedule; MSF proposed an intervention using WHO supported recommendations to develop a feasible model of care as part of one stop model in MCH services

Chamanculo

HBV PMTCT Project - Activities

Hepatitis B testing during ante-natal care servicesHepatitis B treatment and prophylaxis for pregnant women if needHepatitis B newborn vaccination at birth before discharge from maternity;Testing partners and children for HBsAg positive pregnant women, and hepatitis vaccination if neededDesigned and implement a workflow throughout the PMTCT cascade and linkage with MoH services for future intervention sustainability

HBV PMTCT –

Chamanculo

ANC and MaternityNovember 2017 – December 2020HBsAg pos rate: 3.5%HIV

co-infected: 35%

HBV BD: 80%

MTCT: <1% (0.007%)

HBV VL >200,000 –

HBeAg

pos 44%

HBV VL < 200,000 –

HBeAg

pos 3.5%

Achievements

and ChallengesHBsAg RDT integrated in ANC together with HIV and syphilis RDT HBV+ mothers referred to MSF team for HBeAg and HBV VL testing

which are not available

in

MoH

facilities

→

availability

of, at least

HBeAg

(RDT), in all ANC services

HBV BD vaccination

integrated

in

immediate

post-natal care and

immunization

done

by nurse in

delivery

room

As

Chamanculo

is the

only

one

maternity

providing

HBV BD vaccine, babies

born

out of

this

maternity

didn’t

receive

it

. A system of calls and vaccine allocation in

referral

maternities

was

implemented

not

so

succesfully

→

availability

of BD vaccine in all

maternities

Follow

up

after

delivery

was

difficult

as

mother

and babies are

followed

by

other

service (at

risk

consultation),

then

they

need

to come back to

Maternity

just

for HBV consultation

→

integration

of HBV

follow

up in

follow

up routine consultation

MoH

standard registration

tools

(

register

and ANC books)

adapted

by

adding

stamps

for

testing

and vaccination

Next Steps

1.

Follow up with Global Fund’s subsidy for:Acquisition of Rapid tests for HBsAg and HBeAg;Acquisition of TDF for prophylaxis and treatment;2. Follow up with National Immunization program for submission of the proposal for financing request to GAVI3. Develop national clinical protocols for implementation of PMTCT for Hepatitis B;4. Revision of MCH M&E tools to integrate Hepatitis B indicators and variables.

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