Prevention of mother to child of HBV infection_Health Care Workers

The WHO Global Hepatitis Programme (GHP) is developing hepatitis B virus (HBV) guidelines on prevention of mother to child transmission of HBV infection. The update will include recommendations on the use of antiviral therapy (tenofovir) in HBV infected pregnant women in addition to timely birth dose vaccination to prevent HBV mother to child transmission in different settings and regions.

We are engaging health care workers, so that they can express their views on the challenges and feasibility of implementing potential recommendations. We would be grateful if you could share your views through this online tool. The process should take approximately 5 minutes to complete.

Background

In May 2016, the World Health Assembly endorsed the Global Health Sector Strategy (GHSS) on viral hepatitis. To reach the HBV incidence impact target by 2030, HBsAg prevalence in children five years of age should fall below 0.1% with an interim HBsAg prevalence target of 1% by 2020 in this age group. To reduce the incidence of HBV infection, WHO recommends inclusion of the hepatitis B vaccine, including timely birth dose in the Expanded Programme of Immunization. However, a proportion of infants born to HBsAg and HBeAg positive mothers will still become infected despite vaccination. Therefore, when programmes already include timely birth dose, pregnant women with high HBV DNA levels may be considered for antiviral therapy during pregnancy to prevent perinatal HBV infection.

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* 1. In what country do you work?

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* 2. Which of the following best describes your role?

Nurse in hospital

Nurse in community

Nurse in antenatal clinic

Doctor in hospital

Doctor in the community

Doctor in antenatal clinic

Doctor'assistant

Community health worker

Pharmacist

Laboratory scientist

Other (please specify)

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* 3. In your place of work are infants given a timely HBV birth dose vaccination (within 24 hours of birth)?

Yes

I'm not sure/ I don't know

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* 4. In your place of work is there a programme to prevent mother to child transmission of HBV infection in pregnant women?

Yes

No, but pregnant women are treated for their own health

I'm not sure/I don't know

Other (please specify)

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* 5. What do you see as possible advantages to treat pregnant women who are eligible with tenofovir to prevent mother to child transmission of HBV infection?

Prevention of HBV infection of the infant

Care and treatment of the mother

Opportunity to build on HIV and Syphilis services

No advantages

I'm not sure/ I don't know

Other (please specify)

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* 6. What do you see as possible disadvantages to treat HBV infected pregnant women who are eligible with tenofovir to prevent mother to child transmission of HBV infection?

Concerns about the health of the infant

Concerns about the health of the mother (f.e flare after discontinuation of treatment)

Too much pressure on the health system

Concerns that tenofovir treatment could shift attention and resources away from timely birth dose vaccination

Costs

No disadvantages

I am not sure/I don't know

Other (please specify)

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* 7. What challenges do you see in the implementation of treating pregnant women who are eligible with tenofovir to prevent mother to child transmission of HBV infection in your place of work?

Education of health care workers

Education of women living with HBV infection

Availability of HBV DNA tests

Cost of HBV DNA tests

Availability of tenofovir

Cost of tenofovir

Lack of capacity to test for HBV infected pregnant women

Lack of infrastructure to test and treat HBV infected pregnant women

Integration of HBV and HIV and Syphilis PMTCT services

No challenges

Other (please specify)

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* 8. What do you see as possible advantages of adopting HBeAg tests to determine treatment eligibility in HBV infected pregnant women when use of HBV DNA tests is restricted or not possible?

Reduced costs

Increased access to HBV testing for pregnant women

Increased equity for disadvantaged populations

No advantages

I'm not sure/I don't know

Other (please specify)

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* 9. What do you see as possible disadvantages of adopting HBeAg tests to determine treatment eligibility in HBV infected pregnant women when the use of HBV DNA tests is restricted or not possible?

Need for education of health care workers

Need for education of women living with HBV infection

Availability of HBeAg tests

Costs of HBeAg tests

Concerns that HBeAg tests are not precise enough to determine HBV treatment eligibility

Concerns about a false perception that HBeAg is a reference method for assessment of treatment eligibility

Lack of infrastructure

No disadvantages

Other (please specify)

Prevention of mother to child of HBV infection_Health Care Workers

Question Title

* 1. In what country do you work?

Question Title

* 2. Which of the following best describes your role?

Question Title

* 3. In your place of work are infants given a timely HBV birth dose vaccination (within 24 hours of birth)?

Question Title

* 4. In your place of work is there a programme to prevent mother to child transmission of HBV infection in pregnant women?

Question Title

* 5. What do you see as possible advantages to treat pregnant women who are eligible with tenofovir to prevent mother to child transmission of HBV infection?

Question Title

* 6. What do you see as possible disadvantages to treat HBV infected pregnant women who are eligible with tenofovir to prevent mother to child transmission of HBV infection?

Question Title

* 7. What challenges do you see in the implementation of treating pregnant women who are eligible with tenofovir to prevent mother to child transmission of HBV infection in your place of work?

Question Title

* 8. What do you see as possible advantages of adopting HBeAg tests to determine treatment eligibility in HBV infected pregnant women when use of HBV DNA tests is restricted or not possible?

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* 9. What do you see as possible disadvantages of adopting HBeAg tests to determine treatment eligibility in HBV infected pregnant women when the use of HBV DNA tests is restricted or not possible?

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* 10. Do you have any other comments?