Authors (including presenting author) :
Chan TT(1)(2), Ma ACK(1), Lui RN(1)(2), Wong GLH(2), Wong VWS(2)
Affiliation :
(1) Department of Medicine and Therapeutics, Prince of Wales Hospital
(2) Department of Medicine and Therapeutics, The Chinese University of Hong Kong
Introduction :
Global efforts are being made to achieve elimination of chronic hepatitis B virus (HBV) infection by 2030 as per World Health Organization’s vision. Perinatal transmission remains the major risk factor of HBV infection in Hong Kong. Since 2020, a new integrated clinic service model co-run by hepatologists and hepatology nurses has been introduced to prescribe peri-natal Tenofovir for prevention of HBV mother-to-child transmission (MTCT) to mothers who are HBsAg positive with high viral load (HBV DNA > 200,000 IU/mL).
Objectives :
To evaluate the real-world data, patient’s acceptance and satisfaction on the HBV MTCT integrated clinic service.
Methodology :
This is a prospective single-center pilot survey involving pregnant ladies enrolled into the HBV MTCT integrated clinic since February to December 2020. Clinical demographics, liver biochemistry outcomes, treatment side-effects and response from a satisfaction survey were captured.
Result & Outcome :
A total of 28 pregnant ladies were referred by obstetricians, with 1 excluded for low HBV DNA titre, 1 exited MTCT pathway due to elevated baseline ALT 539 IU/L and 3 refused Tenofovir. Among the 23 eligible mothers, 18 (78.3%) were HBeAg positive. The mean age at enrollment was 34 years-old with median gestational age of 18 weeks, mean ALT 30 IU/L and HBV DNA 1.74 x 108 IU/mL. The median gestational age to start Tenofovir was 28 weeks and all mothers had received treatment at least up to 4 weeks after delivery. Most tolerated Tenofovir well, except one stopped prematurely at 34th week of gestation due to increase in fetal movement, poor appetite and palpitations.
So far 13 ladies had managed to stop Tenofovir as per protocol after delivery. 3 (23.1%) had elevated ALT over two times of upper limit of normal at first 4 weeks. None required antiviral reinitiation as ALT spontaneously dropped by 50% in the next 4 weeks.
24 of the referred ladies completed an 18-item questionnaire regarding nursing service on HBV disease management. 96% recognized its help in disease (80% strongly agreed, 16% agreed) and treatment understanding (78.7% strongly agreed, 17.3% agreed), as well as patient empowerment (97.3%). All of them concluded the doctor-nurse collaboration (88% strongly agreed, 12% agreed) was efficient.
