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A joint venture between The University of Melbourne and The Royal Melbourne Hospital

18 Dec 2019

Understanding hepatitis B perinatal prevention in Victoria

A group of researchers from Royal Melbourne Hospital's Victorian Infectious Diseases Reference Laboratory (VIDRL) at the Doherty Institute are trying to better understand how Victoria is progressing in eliminating mother-to-child hepatitis B in Victoria.

The research itself is being undertaken at the World Health Organization (WHO) Collaborating Centre for Viral Hepatitis, also based at the institute. 

In 2016 an estimated 61,000 Victorians were living with chronic hepatitis B (CHB), of whom approximately one third remain undiagnosed1, 2.

An estimated 800 Victorian women living with chronic hepatitis B give birth every year.

Prevention of mother to child transmission of hepatitis B includes antenatal testing to identify women with hepatitis B, monitoring during pregnancy to identify women with higher viral loads that should receive antiviral therapy and infant vaccination at birth and 2,4 and 6 months. 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 mother-to-child transmission (MTCT) is not known.

This research project will 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 elements of the project including (1) data linkage and analysis, (2) evaluating hospital-level system factors associated with care to pregnant women living with hepatitis B and their infants and (3) exploring community understandings and attitudes to service delivery during pregnancy.

Epidemiologist Nicole Romero is leading the first part of the project which is all about linking data together.

“We have linked data from four different sources which allows us to identify pregnant women living with hepatitis B and the interventions that their infants have received. We can then use this to then explore disparities in intervention uptake by service, area of residence and priority populations like women born overseas or Aboriginals and Torres Strait Islander women,” Epidemiologist Nicole Romero said.

Another part of the project that clinician researcher and epidemiologist Dr Nicole Allard will be investigating is how healthcare providers involved in delivery services provide care to these individuals.  

“We will be looking at how the system can be improved to ensure all Victorian women giving birth within the system are getting the same standard of care.

“The complexity is the transition from different services, from primary care GP services to hospitals, we need to understand how comprehensive conversations are between services to ensure women are receiving the best care,” Dr Allard said.

Researcher Nafisa Yussf will be conduct a qualitative study to understand the perspective of the  women in the community , their experiences living with hepatitis B and their pregnancy journey.

“It’s going to be interesting hearing directly from women, getting all of these three elements together will give a very holistic view of what is happening around Victoria,” Nafisa said.

The project will inform public policy and identify areas for system improvements for the delivery of prevention of mother to child transmission of hepatitis B.

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