非洲乙型肝炎出生剂量疫苗接种计划的采用和表现不佳:是时候考虑系统的复杂性了吗? - - 一个全面的审查
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
概括
由于错过了接种疫苗的机会,B型肝炎病毒 (HBV) 母婴传播 (MTCT) 在非洲儿童中仍然很高. 改善产前护理和解决卫生系统障碍对于有效控制HBV至关重要.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 卫生系统研究 卫生系统研究
背景情况:
- 非洲幼儿的慢性乙型肝炎 (CHB) 表明预防乙型肝炎病毒 (HBV) 母婴传播 (MTCT) 的失败.
- 艾滋病毒的共同流行病在非洲加剧了HBV MTCT的风险.
- 对HBV MTCT缓解策略,特别是出生剂量疫苗接种的低最佳实施仍然存在.
研究的目的:
- 在非洲对HBV MTCT风险的证据进行范围审查.
- 评估HBV MTCT缓解策略的现状,重点是出生剂量疫苗接种.
- 确定影响HBV出生剂量疫苗接种计划的采用和执行的卫生系统障碍.
主要方法:
- 一个全面的范围审查88个同行评审和灰色文献来源发表于2000年至2022年之间.
- 对HBV MTCT风险,缓解策略和卫生系统因素的证据分析.
- 开发一个适应的基于系统的逻辑模型来理解程序性能.
主要成果:
- 证据始终显示HBV MTCT的高风险,由HIV共同流行病放大.
- 选择性乙型肝炎出生剂量疫苗接种,在产前护理中没有普遍的HBV查,不足以中断MTCT.
- 显著的卫生系统障碍阻碍了HBV出生剂量疫苗接种计划的普遍采用和最佳性能.
结论:
- 暂停HBV MTCT需要综合的普遍查和及时的出生剂量疫苗接种.
- 解决复杂的卫生系统障碍对于非洲有效的HBV控制计划至关重要.
- 未来的研究应该探索复杂的系统方法,以便在区域范围内扩大HBV出生剂量疫苗接种计划.
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