Hepatitis B virus among pregnant women attending antenatal care services
Export Indicator
A. Percentage of women attending antenatal care services who were tested for HBV surface antigen (HBsAg).
B. Percentage of women attending antenatal care services who were tested for HBsAg and had a positive HBsAg test.
C. Percentage of women attending antenatal care services with a positive HBsAg test who receive additional testing for HBV DNA or, where this is not available, HBV envelope antigen (HBeAg).
D. Percentage of eligible women attending antenatal care services who were treated according to national policy, in line with World Health Organization (WHO) guidelines.
A. Testing pregnant women for HBV in pregnancy is important for their own health, and it is also the first step in the prevention of mother-to-child transmission of HBV. Knowing the testing coverage contributes to quality assessment across the full scope of antenatal care services. This indicator also monitors programmatic targets used for validation in countries with a targeted HBV vaccination birth dose policy.
B. HBsAg positivity rate in antenatal care attendees can be used to monitor the prevalence of HBV in the population and give an indication of the HBV burden in pregnant women.
C. Additional testing for different HBV markers can identify women who are eligible for treatment where there is an increased risk of mother-to-child transmission of HBV that necessitates extra interventions.
D. Not all pregnant women who test positive for HBsAg are eligible for treatment to reduce the risk for mother-to-child transmission of HBV. Treatment coverage is a further measure of sustained service quality throughout antenatal care. This indicator also monitors programmatic targets used for validation in countries with a targeted HBV vaccination birth dose policy.
A. Number of pregnant women attending antenatal care services who were tested for HBsAg.
B. Number of pregnant women attending antenatal care services who tested positive for HBsAg.
C. Number of pregnant women attending antenatal care services with a positive HBsAg who then received HBV DNA testing and/or HBeAg.
D. Number of pregnant women attending antenatal care services who met eligibility criteria and received antiviral treatment.
A. Number of pregnant women attending antenatal care services.
B. Number of pregnant women attending antenatal care services who were tested for HBsAg.
C. Number of pregnant women attending antenatal care services who tested positive for HBsAg.
D. Number of pregnant women attending antenatal care services who were eligible for antiviral treatment.
Numerator/denominator
A. Ideally, national programme records aggregated from health-facility data should be used. However, if such data are not available, data from sentinel surveillance or special studies can be reported. In this case, please give the source and coverage of your data, and provide a comment on how far they are thought to be representative of the national situation.
B. The following sources of data may be used: national programme records aggregated from health-facility data, sentinel surveillance or special surveys that use serological tests. In the comments section, specify the source and coverage of your data: for example, sentinel surveillance of all antenatal care attendees in two of 10 provinces.
C. Ideally, national programme records aggregated from health-facility data should be used. However, if such data are not available, data from sentinel surveillance or special studies can be reported. In this case, please give the source and coverage of your data, and make a comment on how far they are thought to be representative of the national situation.
D. Not all pregnant women who are positive for HBsAg are eligible for treatment. Treatment eligibility is based on available supplementary tests (see the resources under "Further information"). Thus, treatment coverage is based on the number of pregnant women eligible for this treatment.
Data should be recorded daily, and reported quarterly to the national or subnational level. They should also be consolidated annually and reported to WHO.
Age (15-24 and 25+ years)
As per "Method of measurement" (above), please comment on whether the data you are providing are routine programme data deemed to be representative of the entire country.
High indicator values indicate well-integrated services for antenatal care and the prevention of mother-to-child transmission of HBV.
Low indicator values suggest low uptake, availability or integration of testing and follow-up, but they do not provide an indication of where the problem lies.
Programme data will not provide information on key population access to services.
Specific points for the subindicators:
A. Programmes should align antenatal testing for HBV, syphilis and HIV to enhance the effectiveness of their work.
B. Data on HBsAg positivity among pregnant women are not readily available in many of the most affected countries through routine health-system reporting. Knowledge of testing practices within the country should be used to interpret and compare disease trends.
C. Tests to identify eligibility for treatment and risk of mother-to-child transmission of HBV among antenatal care attendees are not always available or routinely monitored in health facilities.
D. Evaluating treatment coverage depends on the appropriate use of eligibility criteria.
Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. Geneva: World Health Organization; 2015 (https://www.who.int/publications/i/item/policy-brief-prevention-care-treatment-persons-chronic-hep-b-WHO-HIV-2015-5).
Prevention of mother to child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/bitstream/handle/10665/333391/9789240002708-eng.pdf?sequence=1&isAllowed=y).