Challenge | Possible Solution |
---|---|
Low awareness of treatment for HBV prevention | |
 There is a gap between government policy and practice for hepatitis B PMTCT in relation to HepB-BD and HBIG in marginalized populations | Implementation of health systems strengthening so policy and practice are aligned e.g. for provision of HepB-BD and HBIG |
 Knowledge of tenofovir to prevent MTCT of hepatitis B is low | Implementation of a HBV test and treat policy in antenatal care in RLS, alongside other routine first ANC screening tests. |
Diagnostic limitations | |
 Misclassification of women with HBV with a single POCT | Accurate POCT or serial or parallel testing of two POCTs |
 Central laboratory required to identify women at high risk of MTCT | Develop new POCT rapid test for HBeAg and/or HBV DNA using a qualitative test with thresholds as needed |
Constrained access to healthcare | |
 Arriving to ANC is constrained by transportation difficulties and costs | Provide integrated care: HBV care coincides with routine antenatal care. Objective assistance e.g. transportation vouchers, if not on foot, to reach ANC can reduce access constraints, at a critical part of the life course. |
 Checkpoint (Police/Military) fees may increase the stress of antenatal care visits | Agree locally on methods that permit pregnant women passage at checkpoints on their way to antenatal care without additional fees |
Risk of Hepatic flare after cessation of antiviral therapy | |
 Hepatic flare risk after tenofovir cessation is uncommon but requires monitoring by ALT | RLS can monitor hepatic flare. New POCT to measure ALT by semi-quantitative measures need to be developed to facilitate this. |
 | Governmental support under universal health coverage for continuation of TDF treatment for eligible people |
Medication issues | |
 Safe storage of medications is difficult in RLS households | Careful counseling helps patients store medication safely |
 Bioavailability of tenofovir may be reduced by typical tropical weather conditions, including in new off-patent TDF products | Best storage practices require electrical power to maintain medications at recommended temperatures in the tropics and bioavailability for newer TDF products may require confirmation |