Blog
About

  • Record: found
  • Abstract: found
  • Article: found
Is Open Access

Point-of-care screening for hepatitis B virus infection in pregnant women at an antenatal clinic: A South African experience

Read this article at

Bookmark
      There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

      Abstract

      Background & aimsElimination of HIV and syphilis mother-to-child transmission (MTCT) has received much attention but little consideration has been given to the possibility of elimination of HBV MTCT. In sub-Saharan Africa, HBV vertical transmission continues to be reported and it remains an important public health problem. This study aimed to assess the feasibility of screening pregnant women for HBV using a point-of-care (POC) test and implementing interventions to prevent HBV MTCT.MethodsIn this observational prospective cohort study, HIV-uninfected pregnant women who consented to testing were screened for HBV using a rapid POC test for HBsAg. Positive results were laboratory-confirmed and tested for HBV DNA and serological markers. Women with viral loads ≥ 20 000 IU/ml received tenofovir (TDF) treatment and all infants received birth-dose HBV vaccine. Two blood samples collected six months apart from HBV-exposed infants within their first year of life were tested for HBV DNA.ResultsOf 144 women who were approached, 134 consented to participating (93% acceptance rate of HBV POC test). Six women tested positive for HBsAg (4.5%; 95% CI 0.99%–8.01%), all confirmed by laboratory testing. Two mothers, M1 and M4, were treated with TDF during their third trimester of pregnancy. Six HBV-exposed infants received the HBV vaccine within 24 hours of birth, of whom two were lost to follow-up and four (including the two born to M1 and M4) had undetectable levels of HBV DNA when tested at the two time points.ConclusionWe found that HBV screening using POC testing fulfilled the criteria considered necessary for implementation. It has acceptable performance, is inexpensive, reliable, and was well accepted by the study participants. Screening pregnant women as part of the HBV MTCT prevention strategy is therefore feasible in a South African clinical setting.

      Related collections

      Most cited references 26

      • Record: found
      • Abstract: found
      • Article: not found

      Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

      Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100,000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade. Bill & Melinda Gates Foundation. Copyright © 2015 Elsevier Ltd. All rights reserved.
        Bookmark
        • Record: found
        • Abstract: found
        • Article: not found

        Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013.

        The quantification of the burden of disease attributable to hepatitis B virus (HBV) infection and the adaptation of prevention and control measures requires knowledge on its prevalence in the general population. For most countries such data are not routinely available. We estimated the national, regional, and global prevalence of chronic HBV infection.
          Bookmark
          • Record: found
          • Abstract: not found
          • Article: not found

          AASLD guidelines for treatment of chronic hepatitis B.

            Bookmark

            Author and article information

            Affiliations
            [1 ] Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
            [2 ] National Health Laboratory Service (NHLS), Tygerberg Hospital, Tygerberg, South Africa
            [3 ] Division of Gastroenterology and Hepatology, Department of Medicine, Stellenbosch University, Tygerberg, Cape Town, South Africa
            [4 ] Division of Urology, Department of Surgical Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
            [5 ] Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Cape Town, South Africa
            [6 ] Institute of Medical Virology, National Reference Centre for Hepatitis-B and D Viruses, Justus-Liebig-University Giessen, German Centre for Infection Research (DZIF), Giessen, Germany
            [7 ] Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
            University of North Carolina at Chapel Hill School of Dentistry, UNITED STATES
            Author notes

            Competing Interests: The authors have declared that no competing interests exist.

            Contributors
            ORCID: http://orcid.org/0000-0003-1729-7915, Role: Data curation, Role: Formal analysis, Role: Investigation, Role: Project administration, Role: Validation, Role: Visualization, Role: Writing – original draft, Role: Writing – review & editing
            Role: Conceptualization, Role: Formal analysis, Role: Funding acquisition, Role: Methodology, Role: Resources, Role: Supervision, Role: Validation, Role: Visualization, Role: Writing – original draft, Role: Writing – review & editing
            Role: Formal analysis, Role: Investigation, Role: Visualization, Role: Writing – review & editing
            Role: Formal analysis, Role: Supervision, Role: Visualization, Role: Writing – original draft, Role: Writing – review & editing
            Role: Formal analysis, Role: Investigation, Role: Visualization, Role: Writing – review & editing
            Role: Conceptualization, Role: Formal analysis, Role: Funding acquisition, Role: Methodology, Role: Visualization, Role: Writing – review & editing
            Role: Conceptualization, Role: Data curation, Role: Formal analysis, Role: Funding acquisition, Role: Methodology, Role: Project administration, Role: Resources, Role: Supervision, Role: Visualization, Role: Writing – original draft, Role: Writing – review & editing
            Role: Editor
            Journal
            PLoS One
            PLoS ONE
            plos
            plosone
            PLoS ONE
            Public Library of Science (San Francisco, CA USA )
            1932-6203
            21 July 2017
            2017
            : 12
            : 7
            28732085
            5521792
            10.1371/journal.pone.0181267
            PONE-D-17-08200
            (Editor)
            © 2017 Chotun et al

            This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

            Counts
            Figures: 0, Tables: 2, Pages: 11
            Product
            Funding
            Funded by: Gilead Förderprogramm Infektiologie
            Award Recipient :
            This work was supported by the Gilead Förderprogramm Infektiologie, "Piloting of rapid test-based screening for hepatitis B in pregnancy in South Africa" to DG, MIA, and WP. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
            Categories
            Research Article
            Biology and life sciences
            Microbiology
            Medical microbiology
            Microbial pathogens
            Viral pathogens
            Hepatitis viruses
            Hepatitis B virus
            Medicine and health sciences
            Pathology and laboratory medicine
            Pathogens
            Microbial pathogens
            Viral pathogens
            Hepatitis viruses
            Hepatitis B virus
            Biology and life sciences
            Organisms
            Viruses
            Viral pathogens
            Hepatitis viruses
            Hepatitis B virus
            Medicine and Health Sciences
            Infectious Diseases
            Infectious Disease Control
            Vaccines
            Biology and Life Sciences
            Microbiology
            Virology
            Viral Transmission and Infection
            Viral Load
            People and Places
            Population Groupings
            Age Groups
            Children
            Infants
            People and Places
            Population Groupings
            Families
            Children
            Infants
            People and places
            Geographical locations
            Africa
            South Africa
            Medicine and Health Sciences
            Women's Health
            Maternal Health
            Pregnancy
            Medicine and Health Sciences
            Women's Health
            Obstetrics and Gynecology
            Pregnancy
            Medicine and health sciences
            Infectious diseases
            Viral diseases
            Hepatitis
            Hepatitis B
            Medicine and health sciences
            Gastroenterology and hepatology
            Liver diseases
            Infectious hepatitis
            Hepatitis B
            Medicine and Health Sciences
            Gastroenterology and Hepatology
            Liver Diseases
            Liver Disease and Pregnancy
            Custom metadata
            All relevant data are in the paper and supporting information. Sensitive information that could compromise the anonymity of the enrolled patients (age and DOB) were not included in the supporting information.

            Uncategorized

            Comments

            Comment on this article