Prevention of mother-to-child transmission of hepatitis B virus in antenatal care and maternity services, Mozambique

Objective: To pilot an intervention on the prevention of mother-to-child transmission (PMTCT) of hepatitis B virus (HBV) in an antenatal care and maternity unit in Maputo, Mozambique, during 2017-2019. Methods: We included HBV in the existing screening programme (for human immunodeficiency virus (HIV) and syphilis) for pregnant women at their first consultation, and followed mother-child dyads until 9 months after delivery. We referred women who tested positive for hepatitis B surface antigen (HBsAg) for further tests, including hepatitis B e antigen (HBeAg) and HBV viral load. According to the results, we proposed tenofovir for their own health or for PMTCT. We administered birth-dose HBV vaccine and assessed infant HBV status at 9 months. Findings: Of 6775 screened women, 270 (4.0%) were HBsAg positive; in those for whom data were available, 24/265 (9.1%) were HBeAg positive and 14/267 (5.2%) had a viral load of > 200 000 IU/mL. Ninety-eight (36.3%) HBsAg-positive women were HIV coinfected, 97 of whom were receiving antiretroviral treatment with tenofovir. Among HIV-negative women, four had an indication for tenofovir treatment and four for tenofovir PMTCT. Of 217 exposed liveborn babies, 181 (83.4%) received birth-dose HBV vaccine, 160 (88.4%) of these < 24 hours after birth. At the 9-month follow-up, only one out of the 134 tested infants was HBV positive. Conclusion: Our nurse-led intervention highlights the feasibility of integrating PMTCT of HBV into existing antenatal care departments, essential for the implementation of the triple elimination initiative. Universal birth-dose vaccination is key to achieving HBV elimination.Piloter une action de prévention d'une transmission de la mère à l'enfant (PTME) du virus de l'hépatite B (VHB) dans une maternité et unité de soins prénataux à Maputo, au Mozambique, entre 2017 et 2019.Nous avons inclus le VHB dans le programme existant visant à dépister le virus de l'immunodéficience humaine (VIH) et la syphilis chez les femmes enceintes lors de leur première consultation. Nous avons également suivi les dyades mère-enfant jusqu'à 9 mois après l'accouchement. Nous avons orienté les femmes positives à la présence de l'antigène de surface (HBsAg) de l'hépatite B vers d'autres tests, dont ceux détectant l'antigène e (HBeAg) et la charge virale du VHB. En fonction des résultats, nous avons proposé un traitement au ténofovir pour leur propre santé ou pour la PTME. Enfin, nous avons administré un vaccin contre le VHB à la naissance et évalué le statut sérologique du nourrisson à neuf mois.Sur 6775 femmes dépistées, 270 (4,0%) étaient positives au HBsAg; parmi celles pour qui des données étaient disponibles, 24/265 (9,1%) étaient positives au HBeAg et 14/267 (5,2%) présentaient une charge virale supérieure à 200 000 UI/ml. Le VIH a en outre été détecté chez 98 (36,3%) femmes positives au HBsAg, 97 d'entre elles faisant l'objet d'un traitement antirétroviral au ténofovir. Parmi les femmes négatives au VIH, quatre avaient reçu des indications de traitement au ténofovir et quatre s'étaient vu conseiller le ténofovir dans le cadre d'une PTME. Sur les 217 bébés exposés, 181 (83,4%) ont été vaccinés contre le VHB à la naissance, 160 (88,4%) d'entre eux moins de 24 heures après leur venue au monde. Lors de la visite de suivi neuf mois après la naissance, seul un des 134 nourrissons testés était positif au VHB.Notre action dirigée par le personnel infirmier démontre qu'il est possible d'intégrer la PTME du VHB dans les départements de soins prénataux existants, une démarche essentielle à la mise en œuvre de l'initiative de triple élimination. La vaccination universelle à la naissance est cruciale pour éradiquer le VHB.(c) 2022 The authors; licensee World Health Organization.Realizar una intervención piloto sobre la prevención de la transmisión maternofilial (PTMF) del virus de la hepatitis B (VHB) en una unidad de asistencia prenatal y maternidad en Maputo, Mozambique, entre 2017 y 2019.Se incluyó el VHB en el programa existente de cribado del virus de la inmunodeficiencia humana (VIH) y de la sífilis para las embarazadas en su primera consulta, y se realizó un seguimiento de las parejas maternofiliales hasta nueve meses después del parto. Se derivó a las mujeres que dieron positivo en la prueba del antígeno de superficie del virus de la hepatitis B (AgHBs) para que se sometieran a otras pruebas, como el antígeno e del virus de la hepatitis B (AgHBe) y la concentración vírica del VHB. Según los resultados, se propuso tenofovir como medida sanitaria o para la PTMF. Por último, se administró la vacuna contra el VHB al nacer y se evaluó el estado serológico del VHB en los lactantes a los nueve meses.De las 6775 mujeres analizadas, 270 (4,0 %) dieron positivo en la prueba del AgHBs; entre las que disponían de datos, 24/265 (9,1 %) eran positivas en la prueba del AgHBe y 14/267 (5,2 %) tenían una concentración vírica superior a 200 000 UI/ml. Noventa y ocho (36,3 %) mujeres con AgHBs positivo estaban coinfectadas por el VIH, 97 de las que recibían tratamiento antirretrovírico con tenofovir. Entre las mujeres con VIH negativo, cuatro tenían indicación de tratamiento con tenofovir y cuatro con tenofovir para la PTMF. De los 217 bebés nacidos vivos expuestos, 181 (83,4 %) recibieron la vacuna contra el VHB al nacer, 160 (88,4 %) de ellos en las primeras 24 horas de vida. En la visita de seguimiento a los nueve meses, solo uno de los 134 lactantes analizados dio positivo en la prueba del VHB.Esta intervención dirigida por enfermeras demuestra la viabilidad de integrar la PTMF del VHB en los departamentos de asistencia prenatal existentes, lo que es esencial para la aplicación de la iniciativa de triple eliminación. La vacunación universal al nacer es fundamental para lograr la erradicación del VHB.(c) 2022 The authors; licensee World Health Organization

Hepatitis C treatment program in Maputo, Mozambique, the challenge of genotypes and key populations: A 5‐year retrospective analysis of routine programmatic data

Abstract Background and Aims Hepatitis C (HCV) programs face challenges, especially linked to key populations to achieve World Health Organization (WHO) goals of eliminating hepatitis. Médecins Sans Frontières and Mozambique's Ministry of Health first implemented HCV treatment in Maputo, in 2016 and harm reduction activities in 2017. Methods We retrospectively analyzed routine data of patients enrolled between December 2016 and July 2021. Genotyping was systematically requested up to 2018 and subsequently in cases of treatment failure. Sustainable virological response was assessed 12 weeks after the end of treatment by sofosbuvir‐daclatasvir or sofosbuvir‐velpatasvir. Results Two hundred and two patients were enrolled, with 159 (78.71%) males (median age: 41 years [interquartile range (IQR): 37.10, 47.00]). Risk factors included drug use (142/202; 70.29%). One hundred and eleven genotyping results indicated genotype 1 predominant (87/111; 78.37%). Sixteen patients presented genotype 4, with various subtypes. The people who used drugs and HIV coinfected patients were found more likely to present a genotype 1. Intention‐to‐treat analysis showed 68.99% (89/129) cure rate among the patients initiated and per‐protocol analysis, 88.12% (89/101) cure rate. Nineteen patients received treatment integrated with opioid substitution therapy, with a 100% cure rate versus 59.37% (38/64) for initiated ones without substitution therapy (p < 0.001). Among the resistance testing performed, NS5A resistance‐associated substitutions were found in seven patients among the nine tested patients and NS5B ones in one patient. Conclusion We found varied genotypes, including some identified as difficult‐to‐treat subtypes. People who used drugs were more likely to present genotype 1. In addition, opioid substitution therapy was key for these patients to achieve cure. Access to second‐generation direct‐acting antivirals (DAAs) and integration of HCV care with harm reduction are crucial to program effectiveness

Correction: High burden of cryptococcal antigenemia and meningitis among patients presenting at an emergency department in Maputo, Mozambique.

[This corrects the article DOI: 10.1371/journal.pone.0250195.]

Novel FujiLAM assay to detect tuberculosis in HIV-positive ambulatory patients in four African countries: a diagnostic accuracy study

International audienceBackground: Development of rapid biomarker-based tests that can diagnose tuberculosis using non-sputum samples is a priority for tuberculosis control. We aimed to compare the diagnostic accuracy of the novel Fujifilm SILVAMP TB LAM (FujiLAM) assay with the WHO-recommended Alere Determine TB-LAM Ag test (AlereLAM) using urine samples from HIV-positive patients.Methods: We did a diagnostic accuracy study at five outpatient public health facilities in Uganda, Kenya, Mozambique, and South Africa. Eligible patients were ambulatory HIV-positive individuals (aged ≥15 years) with symptoms of tuberculosis irrespective of their CD4 T-cell count (group 1), and asymptomatic patients with advanced HIV disease (CD4 count <200 cells per μL, or HIV clinical stage 3 or 4; group 2). All participants underwent clinical examination, chest x-ray, and blood sampling, and were requested to provide a fresh urine sample, and two sputum samples. FujiLAM and AlereLAM urine assays, Xpert MTB/RIF Ultra assay on sputum or urine, sputum culture for Mycobacterium tuberculosis, and CD4 count were systematically carried out for all patients. Sensitivity and specificity of FujiLAM and AlereLAM were evaluated against microbiological and composite reference standards.Findings: Between Aug 24, 2020 and Sept 21, 2021, 1575 patients (823 [52·3%] women) were included in the study: 1031 patients in group 1 and 544 patients in group 2. Tuberculosis was microbiologically confirmed in 96 (9·4%) of 1022 patients in group 1 and 18 (3·3%) of 542 patients in group 2. Using the microbiological reference standard, FujiLAM sensitivity was 60% (95% CI 51-69) and AlereLAM sensitivity was 40% (31-49; p<0·001). Among patients with CD4 counts of less than 200 cells per μL, FujiLAM sensitivity was 69% (57-79) and AlereLAM sensitivity was 52% (40-64; p=0·0218). Among patients with CD4 counts of 200 cells per μL or higher, FujiLAM sensitivity was 47% (34-61) and AlereLAM sensitivity was 24% (14-38; p=0·0116). Using the microbiological reference standard, FujiLAM specificity was 87% (95% CI 85-89) and AlereLAM specificity was 86% (95 CI 84-88; p=0·941). FujiLAM sensitivity varied by lot number from 48% (34-62) to 76% (57-89) and specificity from 77% (72-81) to 98% (93-99).Interpretation: Next-generation, higher sensitivity urine-lipoarabinomannan assays are potentially promising tests that allow rapid tuberculosis diagnosis at the point of care for HIV-positive patients. However, the variability in accuracy between FujiLAM lot numbers needs to be addressed before clinical use

Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study

Background Since the release of the first global hepatitis elimination targets in 2016, and until the COVID-19 pandemic started in early 2020, many countries and territories were making progress toward hepatitis C virus (HCV) elimination. This study aims to evaluate HCV burden in 2020, and forecast HCV burden by 2030 given current trends. Methods This analysis includes a literature review, Delphi process, and mathematical modelling to estimate HCV prevalence (viraemic infection, defined as HCV RNA-positive cases) and the cascade of care among people of all ages (age ≥0 years from birth) for the period between Jan 1, 2015, and Dec 31, 2030. Epidemiological data were collected from published sources and grey literature (including government reports and personal communications) and were validated among country and territory experts. A Markov model was used to forecast disease burden and cascade of care from 1950 to 2050 for countries and territories with data. Model outcomes were extracted from 2015 to 2030 to calculate population-weighted regional averages, which were used for countries or territories without data. Regional and global estimates of HCV prevalence, cascade of care, and disease burden were calculated based on 235 countries and territories. Findings Models were built for 110 countries or territories: 83 were approved by local experts and 27 were based on published data alone. Using data from these models, plus population-weighted regional averages for countries and territories without models (n=125), we estimated a global prevalence of viraemic HCV infection of 0·7% (95% UI 0·7–0·9), corresponding to 56·8 million (95% UI 55·2–67·8) infections, on Jan 1, 2020. This number represents a decrease of 6·8 million viraemic infections from a 2015 (beginning of year) prevalence estimate of 63·6 million (61·8–75·8) infections (0·9% [0·8–1·0] prevalence). By the end of 2020, an estimated 12·9 million (12·5–15·4) people were living with a diagnosed viraemic infection. In 2020, an estimated 641000 (623000–765000) patients initiated treatment. Interpretation At the beginning of 2020, there were an estimated 56·8 million viraemic HCV infections globally. Although this number represents a decrease from 2015, our forecasts suggest we are not currently on track to achieve global elimination targets by 2030. As countries recover from COVID-19, these findings can help refocus efforts aimed at HCV elimination