A Real-world Prospective Study of Mother-to-child Transmission of HBV in China Using a Mobile Health Application (Shield 01)

Background and Aims:The World Health Organization(WHO)Western Pacific Region set a target of eliminating mother-to-child transmission(MTCT)of hepatitis B virus(HBV)by 2030.To assess the feasibility of this target in China,we carried out an epidemiological study to investigate the status quo of MTCT in the real-world setting.Methods:One thousand and eight hepatitis B surface antigen-positive preg-nant women were enrolled at 10 hospitals.Immunoprophy-laxis was administered to infants.In addition,mothers with HBV DNA level>2,000,000 IU/mL were advised to initiate antiviral therapy during late pregnancy.A health application called SHIELD was used to manage the study.Results:Nine hundred and five of the enrolled mothers,with 924 infants,completed the follow-up.Birth-dose hepatitis B vaccine and hepatitis B immunoglobulin were received by 99.7%and 99.7%of infants,respectively,within 24 h after birth.There ;were 446 mothers who received antiviral therapy,including 72.3%of the mothers with HBV DNA level>2,000,000 IU/mL and 21.0%of the mothers with HBV DNA level<2,000,000 IU/mL.Eight infants were infected with HBV.The overall rate of MTCT was 0.9%.Birth defects were rare(0.5%among in-fants with maternal antiviral exposure versus 0.7%among infants without exposure;p=1.00).Conclusions:The MTCT rate was lower than the WHO Western Pacific Region elimina-tion MTCT target in this real-world study,indicating that a comprehensive management composed of immunoprophy-laxis to infants and antiviral prophylaxis to mothers may be a feasible strategy to achieve the 2030 WHO elimination goal.

A public health approach to rapid scale-up of free antiretroviral treatment in China： an ounce of prevention is worth a pound of cure

China＇s rapidly evolving HIV/AIDS epidemic calls for a dramatic expansion of both prevention and treatment services. Official state media recently reported that for the first time, in 2008, HIV/AIDS became China＇s leading cause of death among infectious diseases. Estimates from the Ministry of Health indicate that around 700 000 people were living with HIV and 85 000 people had AIDS in 2007. Initially, HIV-1 infection was confined primarily to certain high-risk populations such as injection drug users （IDU） along drug-trafficking routes, and former plasma donors （FPD） in rural communities in east-central China. Now, however, HIV prevalence is increasing among female sex workers （FSW） and men who have sex with men （MSM）.

Evaluation of PIMA Point-of-care CD4 Analyzer in Yunnan, China

Background： CD4 count is used to determine antiretroviral therapy （ART） eligibility. In China, flow cytometers are mostly located in urban areas with limited access by patients residing in remote areas. In an attempt to address this issue, we conducted a study to validate the performance ofAlere PIMA point-of-care CD4 analyzer. Methods： Venous and finger-prick blood specimens were collected from HIV-positive participants from two voluntary counseling and testing sites in Yunnan Province. Both venous and finger-prick blood specimens were tested with the PIMA analyzer. Venous blood specimens tested with the Becton Dickinson FACSCalibur were used as a reference. Results： Venous specimens from 396 and finger-prick specimens from 387 persons were available for analysis. CD4 counts by PIMA correlated well with those from FACSCalibur with an R2 of 0.91 for venous blood and 0.81 for finger-prick blood. Compared to FACSCalibur, the PIMA analyzer yielded lower counts with a mean bias of- 47.0 cells/μl （limit of agreement, [LOA]： -204-110 cells/μl） for venous blood and -71.0 cells/μl （LOA： -295-153 cells/μl） for finger-prick blood. For a CD4 threshold of 350 cells/μl, the positive predictive value （PPV） of PIMA was 84.2% and 75.7% and the negative predictive value （NPV） was 97.6% and 95.8% for venous and finger-prick blood, respectively. For an ART threshold of 500 cells/μl, the corresponding PPV was 90.3% and 84.0% and NPV was 94.3% and 93.4%, respectively. Conclusions： CD4 counting using venous blood with PIMA analyzers is a feasible alternative to a large flow cytometer to determine ART eligibility.