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. 2024 Apr 9;11(4):ofae150.
doi: 10.1093/ofid/ofae150. eCollection 2024 Apr.

Hepatitis B Virus Prevalence and Transmission in the Households of Pregnant Women in Kinshasa, Democratic Republic of Congo

Camille E Morgan  1 , Patrick Ngimbi  2 , Alix J N Boisson-Walsh  3 , Sarah Ntambua  2 , Jolie Matondo  2 , Martine Tabala  4 , Melchior Mwandagalirwa Kashamuka  4 , Michael Emch  1 , Jessie K Edwards  1 , Kimberly A Powers  1 , Linda James  3 , Nana Mbonze  4 , Samuel Mampunza  2 , Marcel Yotebieng  5 , Peyton Thompson  6 , Jonathan B Parr  3   7
Affiliations

Hepatitis B Virus Prevalence and Transmission in the Households of Pregnant Women in Kinshasa, Democratic Republic of Congo

Camille E Morgan et al. Open Forum Infect Dis. .

Abstract

Background: The World Health Organization Africa region has high regional hepatitis B virus (HBV) prevalence, and evidence suggests more frequent horizontal HBV transmission than other regions. Context-specific epidemiological studies are needed to inform additional HBV prevention measures.

Methods: In the cross-sectional Horizontal and Vertical Transmission of Hepatitis B (HOVER-HBV) study, we introduced HBV surface antigen (HBsAg) screening alongside existing HIV screening as part of routine antenatal care in high-volume maternity clinics in Kinshasa, Democratic Republic of Congo. We recruited households of pregnant women ("index mothers") who were HBsAg-positive and HBsAg-negative, defining households as index-positive and index-negative, respectively. Household members underwent HBsAg testing and an epidemiological survey. We evaluated HBsAg prevalence and potential transmission correlates.

Results: We enrolled 1006 participants from 200 households (100 index-positive, 100 index-negative) across Kinshasa. HBsAg-positivity prevalence was more than twice as high in index-positive households (5.0% [95% confidence interval {CI}, 2.8%-7.1%]) as in index-negative households (1.9% [95% CI, .6%-3.2%]). HBsAg-positivity prevalence was 3.3 (95% CI, .9-11.8) times as high among direct offspring in index-positive versus index-negative households. Factors associated with HBsAg positivity included older age, marriage, and having multiple recent partners or any new sexual partners among index mothers; and older age, lower household wealth, sharing nail clippers, and using street salons among offspring in index-positive households.

Conclusions: Vertical and horizontal HBV transmission within households is ongoing in Kinshasa. Factors associated with infection reveal opportunities for HBV prevention efforts, including perinatal prevention, protection during sexual contact, and sanitation of shared personal items.

Keywords: HBV; horizontal transmission; prevention of mother-to-child transmission (PMTCT); vertical transmission; viral hepatitis.

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Conflict of interest statement

Potential conflicts of interest. J. B. P. and P. T. report nonfinancial support from Abbott Laboratories (donation of hepatitis B laboratory testing and reagents for other studies), and J. B. P. reports consulting for Zymeron Corporation, all outside the submitted work. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Recruitment and enrollment of households of hepatitis B surface antigen (HBsAg)–positive and HBsAg-negative index mothers. *Previous screening occurred before the Horizontal and Vertical Transmission of Hepatitis B (HOVER-HBV) study; total number of women screened not available.
Figure 2.
Figure 2.
Enrolled households by geography and household structure. A, Locations of enrolled households in Kinshasa, Democratic Republic of Congo, by household index status (nhh = 200). B, Household networks by participant hepatitis B surface antigen (HBsAg) status (nind = 1006). C, Categorization of households by patterns of HBsAg positivity among enrolled individuals. *Categories are mutually exclusive. †In 4 index-positive households, index mothers recovered from infection between antenatal recruitment and household enrollment (HBsAg-positive to HBsAg-negative). ‡The index mother had an incident infection between antenatal recruitment and household enrollment (HBsAg-negative to HBsAg-positive). Abbreviations: DRC, Democratic Republic of Congo; HBsAg, hepatitis B surface antigen; IQR, interquartile range.
Figure 3.
Figure 3.
Attributes and practices associated with hepatitis B surface antigen (HBsAg) positivity among index mothers (A) and direct offspring of index-positive households (B). Index mothers’ HBsAg result from recruitment screening used for index mothers and index-positive household grouping of direct offspring. The Supplementary Materials show sensitivity analyses using other definitions of index grouping of households. Unadjusted odds ratio shown as measure of association for index mothers due to case-control recruitment of mothers. Prevalence ratio adjusted for household clustering shown for direct offspring. Abbreviations: CI, confidence interval; HBV, hepatitis B virus; OR, odds ratio; PR, prevalence ratio.
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