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Weak Adoption and Performance of Hepatitis B Birth-Dose Vaccination Programs in Africa: Time to Consider Systems

Tasneem Solomon-Rakiep1,2, Jill Olivier1, Edina Amponsah-Dacosta2

  • 1Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa.

Tropical Medicine and Infectious Disease
|October 27, 2023
PubMed

Insights

Hepatitis B virus (HBV) mother-to-child transmission (MTCT) remains high in African children due to missed vaccination opportunities. Improving antenatal care and addressing health system barriers are crucial for effective HBV control.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Health Systems Research

Background:

  • Chronic hepatitis B (CHB) in young African children indicates failures in preventing mother-to-child transmission (MTCT) of the hepatitis B virus (HBV).
  • The co-epidemic of HIV exacerbates the risk of HBV MTCT in Africa.
  • Suboptimal implementation of HBV MTCT mitigation strategies, particularly birth-dose vaccination, persists.

Purpose of the Study:

  • To conduct a scoping review of the evidence on HBV MTCT risks in Africa.
  • To assess the current status of HBV MTCT mitigation strategies, focusing on birth-dose vaccination.
  • To identify health systems barriers affecting the adoption and performance of HBV birth-dose vaccination programs.

Main Methods:

  • A comprehensive scoping review of 88 peer-reviewed and grey literature sources published between 2000 and 2022.
  • Analysis of evidence on HBV MTCT risk, mitigation strategies, and health systems factors.
  • Development of an adapted systems-based logic model to understand program performance.

Main Results:

  • Evidence consistently shows a high risk of HBV MTCT, amplified by the HIV co-epidemic.
  • Selective hepatitis B birth-dose vaccination, without universal HBV screening in antenatal care, is insufficient to interrupt MTCT.
  • Significant health systems barriers impede the universal adoption and optimal performance of HBV birth-dose vaccination programs.

Conclusions:

  • Interrupting HBV MTCT requires integrated universal screening and timely birth-dose vaccination.
  • Addressing complex health systems barriers is essential for effective HBV control programs in Africa.
  • Future research should explore complex systems approaches for scaling up HBV birth-dose vaccination programs regionally.

Keywords:
Africabirth-dosehealth systemshepatitis Bmaternal and child healthvaccine

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