PMID- 32912268 OWN - NLM STAT- MEDLINE DCOM- 20210122 LR - 20240330 IS - 1475-9276 (Electronic) IS - 1475-9276 (Linking) VI - 19 IP - 1 DP - 2020 Sep 10 TI - Tenofovir for prevention of mother to child transmission of hepatitis B in migrant women in a resource-limited setting on the Thailand-Myanmar border: a commentary on challenges of implementation. PG - 156 LID - 10.1186/s12939-020-01268-3 [doi] LID - 156 AB - BACKGROUND: The aim of this manuscript is to highlight challenges in the implementation of maternal tenofovir disoproxil fumarate (tenofovir) for prevention of mother to child transmission (PMTCT) of hepatitis B virus (HBV) in resource limited setting. Current preventive strategies in resource-limited settings fail mainly due to prohibitive costs of hepatitis B immunoglobulin (HBIG) and a high proportion of homebirths, meaning both HBIG and hepatitis B birth dose vaccine are not given. A new strategy for PMTCT without the necessity of HBIG, could be daily tenofovir commenced early in gestation. Implementation challenges to early tenofovir for PMTCT can provide insight to elimination strategies of HBV as the burden of disease is high in resource-limited settings. METHODS: Challenges encountered during implementation of a study of tenofovir for PMTCT before 20 weeks gestation in rural and resource-limited areas on the Thailand-Myanmar border were identified informally from trial study logbooks and formally from comments from patients and staff at monthly visits. ClinicalTrials.gov Identifier: NCT02995005. MAIN BODY: During implementation 171 pregnant women were hepatitis B surface antigen (HBsAg) positive by point of-care test over 19 months (May-2018 until Dec-2019). In this resource-limited setting where historically no clinic has provided tenofovir for PMTCT of HBV, information provided by staff resulted in a high uptake of study screening (95.5% (84/88) when offered to pregnant women. False positive point-of-care rapid tests hinder a test and treat policy for HBV and development of improved rapid tests that include HBeAg and/or HBV DNA would increase efficiency. Integrated care of HBV to antenatal care, transport assistance and local agreements to facilitate access, could increase healthcare at this critical stage of the life course. As safe storage of medication in households in resource-limited setting may not be ideal, interactive counseling about this must be a routine part of care. CONCLUSION: Despite challenges, results from the study to date suggest tenofovir can be offered to HBV-infected women in resource-limited settings before 20 weeks gestation with a high uptake of screening, high drug accountability and follow-up, with provision of transportation support. This commentary has highlighted practical implementation issues with suggestions for strategies that support the objective of PMTCT and the World Health Organization goal of HBV elimination by 2030. FAU - Bierhoff, M AU - Bierhoff M AUID- ORCID: 0000-0003-2585-1066 AD - Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, 63110, Thailand. mariekebierhoff@yahoo.com. AD - Division of Infectious Diseases, Academic UMC, University of Amsterdam, Amsterdam, The Netherlands. mariekebierhoff@yahoo.com. FAU - Rijken, M J AU - Rijken MJ AD - Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. AD - Julius Global Health, The Julius Centre for Health Sciences, University Medical Centre Utrecht, Utrecht, Netherlands. FAU - Yotyingaphiram, W AU - Yotyingaphiram W AD - Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, 63110, Thailand. FAU - Pimanpanarak, M AU - Pimanpanarak M AD - Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, 63110, Thailand. FAU - van Vugt, M AU - van Vugt M AD - Division of Infectious Diseases, Academic UMC, University of Amsterdam, Amsterdam, The Netherlands. FAU - Angkurawaranon, C AU - Angkurawaranon C AD - Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand. FAU - Nosten, F AU - Nosten F AD - Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, 63110, Thailand. AD - Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK. FAU - Ehrhardt, S AU - Ehrhardt S AD - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. FAU - Thio, C L AU - Thio CL AD - Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. FAU - McGready, R AU - McGready R AD - Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, 63110, Thailand. AD - Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK. LA - eng SI - ClinicalTrials.gov/NCT02995005 GR - WT_/Wellcome Trust/United Kingdom GR - 106698/Z/14/Z/WT_/Wellcome Trust/United Kingdom PT - Letter PT - Research Support, Non-U.S. Gov't DEP - 20200910 PL - England TA - Int J Equity Health JT - International journal for equity in health JID - 101147692 RN - 0 (Antiviral Agents) RN - 0 (Hepatitis B Surface Antigens) RN - 0 (Hepatitis B Vaccines) RN - 0 (Hepatitis B e Antigens) RN - 0 (Immunoglobulins) RN - 99YXE507IL (Tenofovir) RN - XII270YC6M (hepatitis B hyperimmune globulin) SB - IM MH - Adult MH - Antiviral Agents/*therapeutic use MH - Child MH - Female MH - Health Resources MH - *Health Services Accessibility MH - Hepatitis B/blood/*prevention & control/virology MH - Hepatitis B Surface Antigens/blood MH - Hepatitis B Vaccines/administration & dosage MH - Hepatitis B e Antigens/blood MH - Hepatitis B virus/genetics/immunology MH - Humans MH - Immunoglobulins/therapeutic use MH - Infectious Disease Transmission, Vertical/*prevention & control MH - Male MH - Myanmar MH - Pregnancy MH - Pregnancy Complications, Infectious/blood/*drug therapy/virology MH - Prenatal Care MH - Rural Population MH - Tenofovir/*therapeutic use MH - Thailand MH - *Transients and Migrants MH - Vaccination PMC - PMC7488314 OTO - NOTNLM OT - Antiviral therapy OT - Barriers OT - HBV OT - Inequality COIS- The authors declare that they have no competing interests. EDAT- 2020/09/12 06:00 MHDA- 2021/01/23 06:00 PMCR- 2020/09/10 CRDT- 2020/09/11 05:31 PHST- 2020/04/27 00:00 [received] PHST- 2020/08/25 00:00 [accepted] PHST- 2020/09/11 05:31 [entrez] PHST- 2020/09/12 06:00 [pubmed] PHST- 2021/01/23 06:00 [medline] PHST- 2020/09/10 00:00 [pmc-release] AID - 10.1186/s12939-020-01268-3 [pii] AID - 1268 [pii] AID - 10.1186/s12939-020-01268-3 [doi] PST - epublish SO - Int J Equity Health. 2020 Sep 10;19(1):156. doi: 10.1186/s12939-020-01268-3.