Abstract
WHO recommends the sero-vaccination of newborns within the first 24 hours of life and treating pregnant women at risk of transmitting hepatitis B virus (HBV) (viral load> 200,000 IU / ml) with tenofovir to prevent perinatal transmission of HBV.The aim of this work was: i) to assess the prevention of mother-to-child transmission of the hepatitis B virus (PMTCT) as it is now practiced in Ouagadougou; ii) improve it, taking into account the medico-economic possibilities and socio-cultural realities, iii) evaluate a family screening strategy for HBV based on the identification of pregnant women infected with HBV. This thesis work took place in three phases.The first part consisted of an analysis of the hepatitis B care cascade from screening during the prenatal consultation in peripheral health facilities in Ouagadougou to treatment of women at risk of MTCT and vaccination at birth. Résults: of 5200 pregnant women consulting for the antenatal visit, 2261 (43.5%) were proposed pre-test counselling and HBsAg screeningand 2220 (98.2%) have agreed to screening. Among 1580 (71.2%) women thatcame back for the post-counselling interview, 75 were positive for HBsAg (4.8%),73 (97.3% of the women provided HBsAg result) consented to medical consultation with hepatogastroenterologists and 53 (72.6%); performed the HBV DNA testing.Forty-seven out of 60 (78.3%; 65.8-87.9) children born alive were immunized forHBV within 24 hours of life. Retention in care was associated with the level of education of the infant’s father, secondary school or higher was associated with a better retention in care of the women (OR: 6.6; P = .03).In the second part we evaluated a family screening strategy for HBV by chosing the antenatal consultation as an entry point. This last part allows us to assess the obstacles and levers to carrying out screening around an index case such as pregnant women. Results: one thousand pregnant women, found to carry HBsAg, accepted to participate in this study. Of 2,281 spouses and children eligible for the family screening, 651 (28.5%) were successfully tested for HBsAg, including 436/1000 (43.6%) spouses and 215 /1281 (16.8%) children. HBsAg was detected in 55 (12.6%) spouses (median age [IQR]: 33 years [29-38]) and 24 (11.2%) (median age [IQR]: 7 years [4 -12]). HBsAg carriage was higher in those child born before the introduction of hepatitis B vaccination in Burkina Faso in 2006 (4.4 [1.47- 13.15]; p=0.008), among those whose mothers tested positive for hepatitis B e antigen (HBeAg) (11.47 [4.41-29.81]; p=0.0001) and had HBV DNA levels ≥ 200,000 IU/mL (14.04 [4.89-40.28]; p=0.001). PMTCT is a major and essential strategy for achieving the WHO goal of eliminating viral hepatitis as a public health threat by 2030. Several complementary methods of PMTCT exist and they must be chosen by according to the socio-economic realities of our country.