Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Tsui WMV(1), Leung WC(2), Kung KN(3), Lai CHJ(1)
Affiliation :
(1) Department of Quality and Standards, Quality & Safety Division, Hospital Authority Head Office
(2) Department of Obstetrics and Gynaecology, Kwong Wah Hospital
(3) Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
As part of the effort to eliminate viral hepatitis as a public health threat, the World Health Organization has set a target to reduce the prevalence of hepatitis B surface antigen (HBsAg) among children under the age of five to 0.1% by 2030. Despite timely birth dose vaccine, hepatitis B immunoglobulin, and completing the hepatitis vaccine series, mother-to-child transmission of hepatitis B virus (HBV) can still occur. To further reduce the risk of mother-to-child transmission, antiviral prophylaxis is being provided to HBsAg-positive pregnant women with high viral load. The programme began as a pilot run in early 2020 and has been fully implemented across all eight birthing hospitals under the Hospital Authority since August 2020.
Objectives :
The objectives are to (1) further reduce mother-to-child transmission of HBV through antiviral prophylaxis for eligible HBsAg-positive pregnant women, (2) evaluate the acceptance of antiviral prophylaxis among HBsAg-positive pregnant women, and (3) identify reasons for refusal of antiviral prophylaxis among HBsAg-positive pregnant women.
Methodology :
Pregnant women undergo universal screening for HBsAg during each pregnancy. HBV DNA is checked if HBsAg is positive. All HBsAg-positive pregnant women with high viral load (HBV DNA >200,000 IU/ml) are promptly referred to hepatologists for counselling and initiation of antiviral prophylaxis. Tenofovir disoproxil fumarate is initiated between 28-32 weeks of gestation and continued for up to 12 weeks after delivery. Hepatitis nurse clinics provide additional support, including education, side effect monitoring, and follow-up after cessation of antiviral prophylaxis. Other HBsAg-positive pregnant women who do not meet the criteria for antiviral prophylaxis are referred to the appropriate level of care.
Result & Outcome :
Between September 2020 and December 2022, a total of 2151 HBsAg-positive pregnant women attended antenatal clinics under the Hospital Authority. Among them, 328 (15.2%) had high viral load (HBV DNA >200,000 IU/ml) and were promptly referred to hepatologists. Out of these women, 314 (95.7%) attended the medical specialist outpatient clinic. After consultation with hepatologists, most women accepted antiviral prophylaxis, with 292 (93.0%) being prescribed tenofovir disoproxil fumarate. For those who refused antiviral prophylaxis after counselling, common reasons included concerns about potential side effects on their foetus and fears about hepatitis flare-ups after stopping the medication. The results of post-vaccination serologic testing on infants will further inform the outcome of initiatives to prevent mother-to-child transmission of HBV.
