# Antenatal Screening for Hepatitis B Virus in Uganda: Missed Opportunities for Diagnosis and Treatment

## TL;DR

The study found that only a small percentage of pregnant women in Uganda were identified with hepatitis B virus during antenatal care, missing chances to prevent passing the virus to their babies.

## Contribution

The study highlights missed opportunities for HBV screening and treatment in antenatal care in Uganda.

## Key findings

- 2.2% of pregnant women were found to be HBsAg positive at delivery.
- Only 7.6% of HBsAg-positive women were successfully referred for specialist management.

## Abstract

Hepatitis B virus (HBV) infection is a significant cause of morbidity and mortality globally. The World Health Organization estimates that just 10.5% of individuals living with HBV globally are aware of their status. Antenatal care provides an opportunity to screen pregnant women for HBV and to treat those who are eligible to reduce the risk of vertical transmission. We conducted an observational study to determine the proportion of pregnant women with active HBV infection delivering at a government-funded hospital in Kampala, Uganda, to estimate the number of missed opportunities to prevent vertical transmission.

Eligible participants were enrolled via the PROGRESS study, an observational cohort study undertaken in Kampala, Uganda, between November 2018 and April 2021. Results presented here describe data from April 2019 to November 2020. Five milliliters of venous blood was drawn shortly after delivery. Serum aliquots were analyzed for hepatitis B surface antigen (HBsAg). HBsAg-positive participants were informed of their result by telephone and referred to the gastroenterology service for specialist management.

In total, 6062 women were enrolled between April 2019 and November 2020. Results were available for 6012 (99.6%) participants, among whom 131 (2.2%) were HBsAg positive. Only 10 of 131 (7.6%) HBsAg-positive participants were successfully referred to the gastroenterology service at Mulago Hospital for treatment of their infection.

Our study identified a number of missed opportunities to identify active HBV infection among our pregnant cohort. Additional resources are urgently required to increase the coverage of antenatal HBV screening while also improving treatment pathways for pregnant women with HBV infection in this region.

We determined the proportion of pregnant women with active hepatitis B virus (HBV) infection at the moment of delivery in a government-funded hospital in Uganda, and identified a number of missed opportunities to identify HBV infection antenatally and prevent vertical transmission.