Morgan Camille E, Thahir Sahal, Ngimbi Patrick, Mwandagalirwa Melchior Kashamuka, Ntambua Sarah, Matondo Jolie, Tabala Martine, Mbendi Charles, Kaba Didine, Yotebieng Marcel, Parr Jonathan B, Banek Kristin, Thompson Peyton
University of North Carolina at Chapel Hill, Chapel Hill, USA.
Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
medRxiv. 2023 Mar 31:2023.03.30.23287808. doi: 10.1101/2023.03.30.23287808.
Prevention of mother-to-child transmission (PMTCT) programs for hepatitis B virus (HBV) are critical to reach the World Health Organization's 2030 HBV elimination goals. Despite demonstrated feasibility utilizing HIV infrastructure, HBV PMTCT programs are not implemented in many African settings, including in the Democratic Republic of Congo (DRC). In a previous pilot of HBV PMTCT implementation in DRC's capital, Kinshasa, we observed low TDF metabolite levels at delivery among women with high-risk HBV who were given tenofovir disoproxil fumarate (TDF) antiviral therapy. As such, we conducted qualitative interviews with women who received TDF to understand facilitators and barriers of medication adherence. We used a modified Information-Motivation-Behavioral Skills model (IMB+) as a framework for thematic content analysis. We found that trust in healthcare workers, familial support, and improved awareness of the disease and treatment options were important facilitators of TDF adherence; pill size, social stigma, and low HBV knowledge were barriers to adherence. While overall acceptance of TDF was high in this pilot, improved TDF adherence is needed in order to reach efficacious levels for preventing transmission from mothers to newborns. We suggest ongoing HBV sensitization within existing maternity and HIV care infrastructure would address gaps in knowledge and stigma identified here. Additionally, given the trust women have towards maternity center staff and volunteers, scaled HBV PMTCT interventions should include specific sensitization and education for healthcare affiliates, who currently receive no HBV prevention or information in DRC. This study is timely as TDF, particularly future long-acting formulations, could be considered as an alternate rather than adjuvant to birth-dose vaccination for HBV PMTCT in sub-Saharan Africa.
乙型肝炎病毒（HBV）母婴传播预防（PMTCT）项目对于实现世界卫生组织2030年消除HBV的目标至关重要。尽管利用艾滋病毒基础设施已证明具有可行性，但许多非洲地区，包括刚果民主共和国（DRC），并未实施HBV PMTCT项目。在之前于刚果民主共和国首都金沙萨开展的HBV PMTCT实施试点中，我们观察到，接受替诺福韦酯（TDF）抗病毒治疗的高危HBV感染女性在分娩时TDF代谢物水平较低。因此，我们对接受TDF治疗的女性进行了定性访谈，以了解药物依从性的促进因素和障碍。我们使用改良的信息-动机-行为技能模型（IMB+）作为主题内容分析的框架。我们发现，对医护人员的信任、家庭支持以及对疾病和治疗选择认识的提高是TDF依从性的重要促进因素；药丸大小、社会耻辱感和低HBV知识是依从性的障碍。虽然在该试点中TDF的总体接受度较高，但为了达到预防母婴传播的有效水平，仍需要提高TDF的依从性。我们建议在现有的孕产妇和艾滋病毒护理基础设施内持续开展HBV宣传，以解决此处发现的知识和耻辱感方面的差距。此外，鉴于女性对产科中心工作人员和志愿者的信任，扩大规模的HBV PMTCT干预措施应包括对医疗附属人员的特定宣传和教育，目前在刚果民主共和国，这些人员未接受任何HBV预防或信息。这项研究很及时，因为在撒哈拉以南非洲，TDF，特别是未来的长效制剂，可被视为HBV PMTCT出生剂量疫苗接种的替代方案而非辅助方案。
