WHO CC for Viral Hepatitis

22 Feb 2021

Meet the team investigating hepatitis B mother-to-child transmission in Victoria

A group of researchers at the WHO Collaborating Centre for Viral Hepatitis (WHOCCVH) at the Doherty Institute are investigating barriers to eliminating mother-to-child transmission of hepatitis B (MTCT) in Victoria through the Victorian Perinatal Hepatitis B Prevention Research Project. In today’s meet the team, we learn more about the research group and their efforts to understand how Victoria is progressing in eliminating hepatitis B mother-to-child transmission.

Can you introduce yourselves and your roles at the Doherty Institute?

  • Dr Nicole Allard, GP Clinician Researcher and Epidemiologist at the WHOCCVH
  • Nicole Romero, Epidemiologist at the WHOCCVH
  • Nafisa Yussf, Researcher at the WHOCCVH

What is the Victorian Perinatal Hepatitis B Prevention Research Project and why was it created?

In 2016 an estimated 61,000 Victorians were living with chronic hepatitis B (CHB), of whom approximately one third remain undiagnosed. MTCT of hepatitis B can be prevented by diagnosis and treatment of women, and vaccination of infants with hepatitis B vaccine and hepatitis B immunoglobulin (HBIG). Elimination of MTCT is part of the WHO's goals of triple elimination (HIV, Syphilis and HBV) to which Australia is a signatory.

An estimated 800 Victorian women living with CHB give birth every year. While the uptake of antenatal testing for hepatitis B is reported as high, the proportion of women and their infants who receive quality care to prevent MTCT has not previously been known.

This research project aims to comprehensively describe the current status of MTCT of hepatitis B elimination efforts in Victoria, using quantitative and qualitative analyses and assessing all aspects of the health care system. There are three different components of the project including (1) data linkage and analysis, (2) evaluating system level factors associated with care to pregnant women living with hepatitis B and their infants and (3) exploring lived experiences and attitudes to service delivery during and post pregnancy.

The project is large and diverse, combining quantitative and qualitative data to assess all aspects of the healthcare system. One area under investigation is data linkage and analysing data. What have you discovered through this process so far?

Through data linkage, we have been able to identify pregnant women living with CHB and explore the uptake of interventions used to prevent MTCT of hepatitis B. As information about pregnancy, hepatitis B diagnosis and intervention uptake are captured in different and siloed dataset, this is the first time we have been able to look at this question at a population level in Victoria. Initial analysis has shown gaps in service delivery in particular population groups, and we will be working with the Department of Health and Human Services to help address some of the challenges and barriers to improve vaccination uptake.

What intervention and healthcare options are currently available for pregnant people and parents living with hepatitis B?

Prevention of MTCT of hepatitis B involves antenatal testing to identify women with hepatitis B, monitoring during pregnancy to identify women with higher viral loads that should receive antiviral therapy and timely infant vaccination at birth (including HBIG) as well as 2, 4 and 6 months.

How can this be improved?

We have identified several areas where the healtchare options and interventions can be improved. This includes: 

  • Standardisation of CHB patient-centred, culturally appropriate care and management in all health care services 
  • Further hepatitis B management training for staff across health services, including; hospital staff, community practitioners such as GPs, nurses and Maternal and Child Health Nurses
  • Ensuring post vaccination testing is provided for infants born to mothers with CHB to inform the success of interventions and confirm the infants hepatitis B status  
  • Provision of appropriate emotional and social support for mothers with CHB, and their families
  • Regular monitoring and evaluation of the coverage of services to women with CHB and their infants.

What have you learned about the lived experiences and perspectives of pregnant people in the community?

Most women are screened for CHB during pregnancy. Although most women understood the general purpose of the hepatitis B vaccination, there were significant gaps in information provided to mothers around vaccination, breastfeeding with CHB, their own hepatitis B status and post vaccination testing. This resulted in a subsequent gap in their understanding of these issues.

There was also notable fear and worry associated with hepatitis B transmission, with emotional support for mothers identified as a major gap in service delivery. Additionally, some women experienced stigma and discrimination due to their hepatitis B and refugee status.

How can our healthcare system, policymakers and community support pregnant people and new parents living with hepatitis B?

A Victorian Hepatitis B Perinatal Program needs to be developed to better coordinate, communicate amongst health care services and provide consistent holistic and culturally appropriate care for mothers with CHB and their infants. The development of directive hepatitis B policy across Victorian hospitals will ensure consistency of CHB management and care.

From a community perspective, having them involved through co-designing hepatitis B campaigns would help increase understanding and engagement.

Finally, we need to ensure individual's hepatitis B status are properly recorded, along with the healthcare services being offered. Only then will we be able to understand the success of the interventions being offered.