Hepatitis C prevalence and quality of health services among HIV-positive mothers in the Democratic Republic of the Congo.

Hepatitis C virus (HCV) contributes to liver-related morbidity and mortality throughout Africa despite effective antivirals. HCV is endemic in the Democratic Republic of the Congo (DRC) but data on HCV/HIV co-infection in pregnancy is limited. We estimated the prevalence of and risk factors for HCV/HIV co-infection among pregnant women in the Kinshasa province of the DRC. This cross-sectional study was conducted as a sub-study of an ongoing randomized trial to assess continuous quality improvement interventions (CQI) for prevention of mother-to-child transmission (PMTCT) of HIV (CQI-PMTCT study, NCT03048669). HIV-infected women in the CQI-PMTCT cohort were tested for HCV, and risk factors were evaluated using logistic regression. The prevalence of HCV/HIV co-infection among Congolese women was 0.83% (95% CI 0.43-1.23). Women who tested positive for HCV were younger, more likely to live in urban areas, and more likely to test positive during pregnancy versus postpartum. HCV-positive women had significantly higher odds of infection with hepatitis B virus (HBV) (aOR 13.87 [3.29,58.6]). An inverse relationship was noted between HCV infection and the overall capacity of the health facility as measured by the service readiness index (SRI) (aOR:0.92 [0.86,0.98] per unit increase). Women who presented to rural, for-profit and PEPFAR-funded health facilities were more likely to test positive for HCV. In summary, this study identified that the prevalence of HCV/HIV co-infection was < 1% among Congolese women. We also identified HBV infection as a major risk factor for HCV/HIV co-infection. Individuals with triple infection should be linked to care and the facility-related differences in HCV prevalence should be addressed in future studies.

Prevention of Vertical Transmission of Hepatitis B Within a North Carolina Hospital System.

PURPOSE: Hepatitis B virus (HBV) is a major contributor to liver-related disease globally. Vertical transmission of hepatitis B can lead to devastating outcomes in neonates, making prevention of transmission essential. Fortunately, prevention is possible with evidence-based interventions via guidelines from the American Association for the Study of Liver Diseases (AASLD). The purpose of this study was to assess compliance with AASLD guidelines at a tertiary referral hospital in North Carolina, and to suggest future quality improvement initiatives to improve care for this population. METHODS: We performed a retrospective chart review, including data from all HBV-positive birthing persons at the tertiary referral hospital from April 1, 2014 through December 31, 2019. Data was then compared to AASLD guidelines. FINDINGS: We identified 99 birthing persons who were hepatitis B positive at time of birth. Of the 99 birthing person/neonate dyads, nearly all infants received appropriate and timely HBV birth dose vaccination and HBIG administration. Risk status of HBV-infected birthing persons was completed in only 58% of this population. Of the individuals who were found to be high risk for vertical transmission of HBV, 75% received antiviral prophylaxis. IMPLICATIONS: This study provides a current assessment of prevention practices in vertical transmission of HBV compared to published guidelines. The tertiary hospital studied generally implemented AASLD recommendations for prevention of vertical transmission. However, our data revealed that appropriate risk status testing could be improved. With improvement in risk status testing, antiviral prophylaxis can be provided, decreasing the likelihood of breakthrough HBV vertical transmission. Follow-up for HBV-infected birthing persons and HBV-exposed neonates is also a priority. Achieving full compliance with AASLD guidelines to prevent vertical transmission of HBV is possible, and we provide structure for quality improvement initiatives that aim to accomplish this.