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Abstract Details
Adherence to pregnancy hepatitis B care guidelines in women and infants in the and evaluation of two interventions to improve care: a multi-center hospital-based study
J Viral Hepat. 2020 Dec 29. doi: 10.1111/jvh.13459. Online ahead of print.
Tatyana Kushner1, Elianna Kaplowitz2, Rena Mei3, Chelsea Xu4, Alex Acker5, Emma Rosenbluth1, Igbagbosanmi Oredein4, Monika Sarkar4, Norah Terrault6, Meena Bansal1, Kimberly A Forde78
Author information
1Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
2Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
3Department of Medicine, New York-Presbyterian/ Columbia University Irving Medical Center, New York, NY, USA.
4Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA.
5Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
6Division of Gastrointestinal and Liver Diseases, Keck Medicine of University of Southern California, Los Angeles, California, USA.
7Department of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
8Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
There has been an increase in hepatitis B (HBV) detection during pregnancy in the U.S. and an emphasis on measures to decrease mother-to-child transmission of HBV. We performed a multicenter retrospective study (2015-2018) evaluating care among all women with HBV during pregnancy. We determined rates and predictors of adherence to key maternal care measures including: 1) referral to HBV specialty care, 2) assessment of HBV DNA, and 3) initiation of antiviral therapy, and 4) rates of HBIG and HBV vaccine completion in infants. We evaluated two interventions to improve HBV care, 1) clinical decision support with best practice alert, and 2) co-location of HBV care in obstetrics department. We identified 372 women with HBV during pregnancy. Patients had a median age of 33 (IQR 29, 36), were mostly of Asian (49%) or Black (36%) race, HBeAg negative (83%) with HBV DNA ≤ 2000 Iu/mL (65%) and maximum ALT ≤25 (66%). Regarding care measures, 62% were referred to an HBV specialist, 85% had HBV DNA checked during pregnancy and 68% with HBV DNA ≥200,000 were initiated on antiviral therapy. Co-located obstetric-liver diseases clinics appeared to improve adherence to maternal care measures. All infants received HBIG and the first HBV vaccine dose, 106 (81%) received the second, 94 (74%) received the 3rd dose, but fewer at the recommended time intervals. We identified clear gaps in adherence to HBV care measures for both mothers and infants. Co-location of HBV care in the obstetrics department shows promise in improving adherence to maternal care measures.