Obstetrics

1. Plans for the Introduction
of Hepatitis B Birth Dose in
Mozambique
Helga Guambe, MOH Mozambique

2. Background (1)
• Population size 30,853,842 people
• Total maternity wards 1,391
• Fertility rate of 5.3%
• 1st ANC coverage 115%
• 4th ANC coverage 58,5%
• Live births 1,150,089 (2020)
• 85% institutional deliveries
• Prevalence of HIV (15-49 years) 13.2% (IMASIDA
2015)
(SISMA 2020)

3. Background (2)
Vaccination coverage levels for:
• HBV (pentavalent; DPT/Hep B/HIB ) vaccine
available since 2004 as part of the
immunization schedule for all children
• Vaccines given at birth (OPV0, BCG) –
OPV0- 107%, BCG 124%
• DPT1/Hep B/HIB coverage: 117%
• DPT 3/Hep B/HIB coverage: 108%
(SISMA 2020)

4. Background (3)
•Hepatitis B birth dose is not provided
in the country but has been approved
by the national immunization
committee to be implemented in the
country
•However the Hep B birth dose is
included in the National Plan for the
Triple Elimination of Vertical
Transmission (HIV, Syphilis and Hep. B)
(SISMA 2020)

5. Background (4)
Despite limited data, prevalence of HBV in Mozambique is thought to be
high
• Estimated prevalence of HBsAg
• general population –7.2%
• women of reproductive age –10 % (2017 modeling report)
• ART naive HIV-positive –7.6% (95%CI 6.1-9.3) with 25% of all HBsAg+
having a HBV viral load (VL)> 8,617,488 IU/mL)
• Study conducted in a youth clinic (median age 16.6 years) in Maputo –
12.2% (95%CI 10.5%-14.0%).
Font: Public Health impact of a population based approach to HBV and HCV prevention and treatment in Mozambique

6. Hepatitis B Screening and Prevention Policy (1)
1. HBsAg screening of pregnant women
National policy to screen all pregnant women, in
the first ante-natal visit, preferably in the 1st
trimester of pregnancy
2019

7. Hepatitis B Screening and Prevention Policy (2)
2. Treatment guidelines for infected pregnant women
at ANC:
• HBV/HIV co-infected pregnant women, TDF/3TC/DTG as
per national first line ARV protocol
• HBV mono-infected pregnant women evaluated for
eligibility to start antiviral prophylaxis with TDF from 28
weeks of gestation or treatment with TDF or Entecavir
(ETV) if necessary
2019

8. Hepatitis B Screening and Prevention Policy (3)
3. National PMTCT Triple Elimination Plan Objectives:
1. Integrate the birth dose of Hepatitis B into the
national vaccination schedule;
2. Start HBsAg testing at ANCs as soon as a basic
package is available for prevention, diagnosis and
treatment of Hepatitis B;
3. Assess cost-effectiveness in the context of
Mozambique on the use of antivirals to prevent
HBV Vertical transmission;
4. Integrate Hepatitis B indicators into M&E system

9. HBV PMTCT – Chamanculo ANC and
Maternity

10. Chamanculo HBV PMTCT Project
Strategy for preventing hepatitis B vertical transmission focused on use of tenofovir for
pregnant women and introduction of birth-dose vaccine considering:
1. Mozambique is a LMIC with high transmission for HBV
2. There are patients who need Hepatitis B treatment following WHO
recommendations, and are not receiving it
3. Hepatitis B vaccine birth dose is not included in national immunization schedule;
MSF proposed an intervention using WHO supported recommendations to develop a
feasible model of care as part of one stop model in MCH services

11. Chamanculo HBV PMTCT Project - Activities
• Hepatitis B testing during ante-natal care services
• Hepatitis B treatment and prophylaxis for pregnant women if need
• Hepatitis B newborn vaccination at birth before discharge from maternity;
• Testing partners and children for HBsAg positive pregnant women, and hepatitis
vaccination if needed
• Designed and implement a workflow throughout the PMTCT cascade and linkage
with MoH services for future intervention sustainability

12. HBV PMTCT – Chamanculo ANC and Maternity
November 2017 – December 2020
HBsAg
pos rate:
3.5%
HIV co-
infected:
35%
HBV BD:
80%
MTCT: <1%
(0.007%)
HBV VL >200,000 – HBeAg pos 44%
HBV VL < 200,000 – HBeAg pos 3.5%

13. Achievements and Challenges
• HBsAg RDT integrated in ANC together with HIV and syphilis RDT
• HBV+ mothers referred to MSF team for HBeAg and HBV VL testing which are not available
in MoH facilities → availability of, at least HBeAg (RDT), in all ANC services
• HBV BD vaccination integrated in immediate post-natal care and immunization done by
nurse in delivery room
• As Chamanculo is the only one maternity providing HBV BD vaccine, babies born out of this
maternity didn’t receive it. A system of calls and vaccine allocation in referral maternities
was implemented not so succesfully → availability of BD vaccine in all maternities
• Follow up after delivery was difficult as mother and babies are followed by other service (at
risk consultation), then they need to come back to Maternity just for HBV consultation →
integration of HBV follow up in follow up routine consultation
• MoH standard registration tools (register and ANC books) adapted by adding stamps for
testing and vaccination

14. Next Steps
1. Follow up with Global Fund’s subsidy for:
• Acquisition of Rapid tests for HBsAg and HBeAg;
• Acquisition of TDF for prophylaxis and treatment;
2. Follow up with National Immunization program for submission of the proposal for
financing request to GAVI
3. Develop national clinical protocols for implementation of PMTCT for Hepatitis B;
4. Revision of MCH M&E tools to integrate Hepatitis B indicators and variables.

15. THANK YOU