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[Preprint]. 2023 Mar 31:2023.03.30.23287808.
doi: 10.1101/2023.03.30.23287808.

Participant perspectives to improve tenofovir adherence in the prevention of mother-to-child transmission of hepatitis B virus in Kinshasa, DRC

Camille E Morgan  1 , Sahal Thahir  1 , Patrick Ngimbi  2 , Melchior Kashamuka Mwandagalirwa  2 , Sarah Ntambua  2 , Jolie Matondo  2 , Martine Tabala  2 , Charles Mbendi  3 , Didine Kaba  2 , Marcel Yotebieng  4 , Jonathan B Parr  1 , Kristin Banek  1 , Peyton Thompson  1
Affiliations

Participant perspectives to improve tenofovir adherence in the prevention of mother-to-child transmission of hepatitis B virus in Kinshasa, DRC

Camille E Morgan et al. medRxiv. .

Abstract

Prevention of mother-to-child transmission (PMTCT) programs for hepatitis B virus (HBV) are critical to reach the World Health Organization's 2030 HBV elimination goals. Despite demonstrated feasibility utilizing HIV infrastructure, HBV PMTCT programs are not implemented in many African settings, including in the Democratic Republic of Congo (DRC). In a previous pilot of HBV PMTCT implementation in DRC's capital, Kinshasa, we observed low TDF metabolite levels at delivery among women with high-risk HBV who were given tenofovir disoproxil fumarate (TDF) antiviral therapy. As such, we conducted qualitative interviews with women who received TDF to understand facilitators and barriers of medication adherence. We used a modified Information-Motivation-Behavioral Skills model (IMB+) as a framework for thematic content analysis. We found that trust in healthcare workers, familial support, and improved awareness of the disease and treatment options were important facilitators of TDF adherence; pill size, social stigma, and low HBV knowledge were barriers to adherence. While overall acceptance of TDF was high in this pilot, improved TDF adherence is needed in order to reach efficacious levels for preventing transmission from mothers to newborns. We suggest ongoing HBV sensitization within existing maternity and HIV care infrastructure would address gaps in knowledge and stigma identified here. Additionally, given the trust women have towards maternity center staff and volunteers, scaled HBV PMTCT interventions should include specific sensitization and education for healthcare affiliates, who currently receive no HBV prevention or information in DRC. This study is timely as TDF, particularly future long-acting formulations, could be considered as an alternate rather than adjuvant to birth-dose vaccination for HBV PMTCT in sub-Saharan Africa.

Keywords: Africa; HBV; PMTCT; antenatal care; pregnancy; tenofovir disoproxil fumarate.

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Conflict of interest statement

Outside of the submitted work, JP reports research support from Gilead Sciences; non-financial support from Abbott Diagnostics; and consulting for Zymeron Corporation.

Figures

Figure 1.
Figure 1.. A modified Information-Motivation-Behavioral Skills (IMB+) model for analysis of tenofovir adherence among pregnant women in the DRC.
The positive or negative influences of these factors are indicated by plus and minus signs, respectively.
See this image and copyright information in PMC

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