Hepatitis A virus seroprevalence among children and adolescents in a high-burden HIV setting in urban South Africa

Scientific Reports, Volume 12, No. 1, Year 2022

Interpretation

Hepatitis A virus (HAV) infection is one of the most important global causes of viral hepatitis. Recent reviews suggested that HAV endemicity in South Africa could shift from high to intermediate. A hospital-based HAV seroprevalence study was conducted between February 2018 and December 2019 in Pretoria, South Africa. Systematic sampling was performed on children and adolescents (1–15 years) who attended outpatient services. Participants with a known HIV status and valid HAV serology results were included. Of the 1220 participants, the median age was 7 years (IQR: 4–11), with 648 (53.11%) males and 572 (46.89%) females. Of 628 (51.48%) HIV-infected participants, most (329, 71.83%) were both immunologically and virologically controlled or had low-level viremia (74, 16.16%). Almost three-quarters (894, 73.28%) were living in formal dwellings, and just over half (688, 56.39%) had access to clean water sources inside the house. Increasing age was associated with testing HAV IgG-positive (OR 1.25; 95% CI 1.20–1.30, p < 0.001), with 19.8% of participants one year of age compared with 86.7% of participants 15 years of age. This study suggests that South Africa has an intermediate HAV seroprevalence, with rates < 90% by 10 years of age (68.6%). Increased age and informal dwellings are statistically associated with HAV seropositivity, while HIV status does not significantly influence HAV seropositivity. A hospital-based cross-sectional analytical study was carried out. A probability sampling method was adopted using systematic sampling (screening and recruiting the 5th registered patient in the subsequent clinic queue) of children aged 1–15 years attending weekday outpatient department services and clinics at Kalafong Provincial Tertiary Hospital in Pretoria, South Africa. Recruitment was performed between February 2018 and December 2019. Children and adolescents with minor illnesses (i.e. illnesses not necessitating admission) and/or those attending follow-up visits were enrolled once written parental consent and patient assent (> 8 years) were obtained. Participants and their caregivers were interviewed using a standardized questionnaire, and blood samples were collected for anti-HAV IgM and IgG testing. Anti-HAV serology testing (both IgM and IgG) was performed using the Abbott ARCHITECT i2000SR immunoassay analyzer. Only participants with a known HIV status (laboratory evidence of HIV-infected or HIV-uninfected status) and valid anti-HAV IgM and IgG results were included in the study. HIV-infected participants were recruited from the paediatric HIV clinic, a weekday clinic for HIV-infected children and adolescents. All HIV-infected children and adolescents have access to age-appropriate universal antiretroviral therapy at the clinic. The sample size was calculated assuming the frequency of HAV IgG to be 50%, with power set at 80% and precision at 5%. The results of these assumptions give a sample size of 383 per age group: 1–5 yrs; 6–10 yrs; 11–15 yrs. The total sample size of the study was calculated to be 1149. The percentages of Hepatitis A IgG- and IgM-positive results, as well as variables associated with these results, are reported as proportions of study participants. Participant age was reported as the median with interquartile range (IQR) in years. A multivariable logistic regression analysis was performed, during which odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to determine whether specific participant characteristics were associated with positive hepatitis A IgG serostatus. Ten variables were included in the model, namely, age of the participant (as a numerical variable), HIV status of participant, maternal HIV status during pregnancy with participant, participant residence (informal dwelling or not), participant access to running tap water inside place of residence, pit latrine ablution facilities at place of residence, employment status of primary caregiver, participant attendance at day-care and/or school, caregiver receipt of a government support grant, and caregiver level of education. Inclusion in the multivariable model was dependent on an associated univariable logistic regression p value of < 0.2. Statistical analysis was performed using R version 3.6.3. All methods were carried out in accordance with relevant guidelines and regulations. The research protocol was approved by the University of Pretoria Medical Research Ethics Committee 362/2017. Informed consent and assent (where applicable) were obtained from all subjects and/or their legal guardian(s). All patient data and laboratory results were anonymised, kept confidential and stored in a password-protected database.

AI Digest

Study Justification:

– Hepatitis A virus (HAV) infection is a significant global cause of viral hepatitis.
– Recent reviews suggest that HAV endemicity in South Africa may be shifting from high to intermediate.
– Understanding the seroprevalence of HAV among children and adolescents in a high-burden HIV setting in urban South Africa is crucial for public health planning and interventions.

Study Highlights:

– A hospital-based HAV seroprevalence study was conducted in Pretoria, South Africa.
– The study included children and adolescents aged 1-15 years who attended outpatient services.
– Of the 1220 participants, 51.48% were HIV-infected.
– The study found that South Africa has an intermediate HAV seroprevalence, with rates below 90% by 10 years of age.
– Increasing age and informal dwellings were associated with HAV seropositivity, while HIV status did not significantly influence HAV seropositivity.

Study Recommendations:

– Based on the study findings, it is recommended to prioritize HAV vaccination programs targeting children and adolescents in South Africa.
– Public health interventions should focus on increasing access to clean water sources and improving living conditions, particularly in informal dwellings.
– Further research is needed to understand the impact of HIV infection on HAV seroprevalence and to develop tailored interventions for HIV-infected individuals.

Key Role Players:

– Ministry of Health: Responsible for policy development and implementation of vaccination programs.
– Healthcare providers: Involved in administering HAV vaccines and providing education on prevention.
– Community leaders and organizations: Engaged in raising awareness and promoting hygiene practices.
– Researchers and scientists: Conducting further studies to monitor HAV seroprevalence and evaluate intervention strategies.

Cost Items for Planning Recommendations:

– Vaccine procurement and distribution: Budget for purchasing HAV vaccines and ensuring their availability in healthcare facilities.
– Training and capacity building: Funds for training healthcare providers on vaccine administration and education programs.
– Public awareness campaigns: Budget for developing and implementing campaigns to raise awareness about HAV and promote preventive measures.
– Infrastructure improvement: Funding for improving water and sanitation facilities in informal dwellings.
– Research funding: Resources for conducting further studies and monitoring the impact of interventions.
Please note that the provided cost items are general categories and the actual cost estimates would depend on the specific context and implementation plans.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides specific details about the study design, sample size, data collection methods, and statistical analysis. However, it does not mention the specific results of the study or any limitations. To improve the evidence, the abstract could include a summary of the main findings and potential implications, as well as a brief discussion of any limitations or areas for further research.

Abstract

Hepatitis A virus (HAV) infection is one of the most important global causes of viral hepatitis. Recent reviews suggested that HAV endemicity in South Africa could shift from high to intermediate. A hospital-based HAV seroprevalence study was conducted between February 2018 and December 2019 in Pretoria, South Africa. Systematic sampling was performed on children and adolescents (1–15 years) who attended outpatient services. Participants with a known HIV status and valid HAV serology results were included. Of the 1220 participants, the median age was 7 years (IQR: 4–11), with 648 (53.11%) males and 572 (46.89%) females. Of 628 (51.48%) HIV-infected participants, most (329, 71.83%) were both immunologically and virologically controlled or had low-level viremia (74, 16.16%). Almost three-quarters (894, 73.28%) were living in formal dwellings, and just over half (688, 56.39%) had access to clean water sources inside the house. Increasing age was associated with testing HAV IgG-positive (OR 1.25; 95% CI 1.20–1.30, p < 0.001), with 19.8% of participants one year of age compared with 86.7% of participants 15 years of age. This study suggests that South Africa has an intermediate HAV seroprevalence, with rates 8 years) were obtained. Participants and their caregivers were interviewed using a standardized questionnaire, and blood samples were collected for anti-HAV IgM and IgG testing. Anti-HAV serology testing (both IgM and IgG) was performed using the Abbott ARCHITECT i2000SR immunoassay analyzer. Only participants with a known HIV status (laboratory evidence of HIV-infected or HIV-uninfected status) and valid anti-HAV IgM and IgG results were included in the study. HIV-infected participants were recruited from the paediatric HIV clinic, a weekday clinic for HIV-infected children and adolescents. All HIV-infected children and adolescents have access to age-appropriate universal antiretroviral therapy at the clinic. The sample size was calculated assuming the frequency of HAV IgG to be 50%, with power set at 80% and precision at 5%. The results of these assumptions give a sample size of 383 per age group: 1–5 yrs; 6–10 yrs; 11–15 yrs. The total sample size of the study was calculated to be 1149. The percentages of Hepatitis A IgG- and IgM-positive results, as well as variables associated with these results, are reported as proportions of study participants. Participant age was reported as the median with interquartile range (IQR) in years. A multivariable logistic regression analysis was performed, during which odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to determine whether specific participant characteristics were associated with positive hepatitis A IgG serostatus. Ten variables were included in the model, namely, age of the participant (as a numerical variable), HIV status of participant, maternal HIV status during pregnancy with participant, participant residence (informal dwelling or not), participant access to running tap water inside place of residence, pit latrine ablution facilities at place of residence, employment status of primary caregiver, participant attendance at day-care and/or school, caregiver receipt of a government support grant, and caregiver level of education. Inclusion in the multivariable model was dependent on an associated univariable logistic regression p value of < 0.2. Statistical analysis was performed using R version 3.6.3. All methods were carried out in accordance with relevant guidelines and regulations. The research protocol was approved by the University of Pretoria Medical Research Ethics Committee 362/2017. Informed consent and assent (where applicable) were obtained from all subjects and/or their legal guardian(s). All patient data and laboratory results were anonymised, kept confidential and stored in a password-protected database.

Materials

https://efashare.b-cdn.net/materials/0f998b56f0e052f9ab666d6a74cce3eb2c9ec5d59352ced8d5d7c3d1b4017f5a/41598_2022_25064_MOESM1_ESM.docx

Innovations

Based on the provided description, it seems that the focus is on studying the seroprevalence of Hepatitis A virus (HAV) among children and adolescents in a high-burden HIV setting in urban South Africa. The study collected data through interviews, blood samples, and analysis using the Abbott ARCHITECT i2000SR immunoassay analyzer. The study also included various participant characteristics and variables for analysis.

To improve access to maternal health, here are some potential recommendations based on the information provided:

1. Integration of maternal health services: Consider integrating maternal health services with the existing HIV clinics or outpatient departments. This would allow for comprehensive care and easy access to both HIV-related services and maternal health services.

2. Strengthening health education: Provide targeted health education programs for caregivers and pregnant women, focusing on the prevention and management of Hepatitis A and other infectious diseases. This can help increase awareness and promote healthy behaviors.

3. Improved access to clean water sources: Since access to clean water sources inside the house was mentioned as a variable, efforts should be made to improve access to clean water in informal dwellings. This can be achieved through infrastructure development and community-based initiatives.

4. Collaboration with community organizations: Collaborate with community organizations and NGOs to reach out to pregnant women and caregivers in informal dwellings. These organizations can provide support, education, and resources to improve maternal health outcomes.

5. Enhancing antenatal care services: Strengthen antenatal care services by ensuring that all pregnant women have access to regular check-ups, screenings, and vaccinations. This can help identify and manage any potential health risks, including Hepatitis A.

6. Promoting vaccination programs: Implement and promote vaccination programs for Hepatitis A among children and adolescents. This can help reduce the burden of the disease and protect vulnerable populations.

7. Improving healthcare infrastructure: Invest in improving healthcare infrastructure, particularly in high-burden areas, to ensure that pregnant women have access to quality maternal health services, including testing and treatment for infectious diseases.

These recommendations aim to improve access to maternal health by addressing specific factors identified in the study, such as access to clean water, integration of services, and targeted education. It is important to consider the local context and engage stakeholders in the implementation of these recommendations.

AI Innovations Description

Based on the provided description, the study conducted a hospital-based HAV seroprevalence study in Pretoria, South Africa, to assess the prevalence of Hepatitis A virus (HAV) infection among children and adolescents. The study found that South Africa has an intermediate HAV seroprevalence, with rates below 90% by 10 years of age. Increased age and informal dwellings were statistically associated with HAV seropositivity, while HIV status did not significantly influence HAV seropositivity.

To improve access to maternal health, the following recommendations can be developed into an innovation:

1. Education and Awareness: Develop educational programs and campaigns to raise awareness about the importance of maternal health and the risks associated with HAV infection during pregnancy. This can include providing information on preventive measures, such as vaccination and hygiene practices.

2. Vaccination Programs: Implement vaccination programs targeting pregnant women to protect them from HAV infection. This can be done by integrating HAV vaccination into routine antenatal care services and ensuring access to affordable and safe vaccines.

3. Improved Water and Sanitation: Address the issue of informal dwellings and lack of access to clean water sources inside houses. Implement initiatives to improve water and sanitation infrastructure in communities, ensuring that pregnant women have access to clean water for drinking, cooking, and hygiene purposes.

4. Integration of Services: Integrate HAV screening and vaccination services into existing maternal health programs. This can be done by training healthcare providers on HAV prevention and incorporating HAV-related interventions into antenatal care visits.

5. Collaboration and Partnerships: Foster collaboration between healthcare providers, government agencies, non-governmental organizations, and community stakeholders to develop comprehensive strategies for improving access to maternal health. This can involve sharing resources, expertise, and best practices to ensure a coordinated and effective approach.

By implementing these recommendations, it is possible to develop an innovation that improves access to maternal health and reduces the risk of HAV infection during pregnancy. This can ultimately contribute to better maternal and child health outcomes in South Africa.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthening healthcare infrastructure: Investing in the development and improvement of healthcare facilities, particularly in rural areas, can enhance access to maternal health services. This includes building and equipping clinics and hospitals, ensuring the availability of essential medical supplies and equipment, and training healthcare professionals.

2. Mobile health (mHealth) interventions: Utilizing mobile technology to deliver maternal health services can overcome geographical barriers and reach remote populations. This can involve sending SMS reminders for antenatal care appointments, providing educational information through mobile apps, and facilitating telemedicine consultations for prenatal check-ups.

3. Community-based interventions: Engaging local communities and community health workers can improve access to maternal health services. This can involve training community health workers to provide basic antenatal and postnatal care, conducting awareness campaigns on maternal health, and establishing support groups for pregnant women.

4. Financial incentives: Providing financial incentives, such as cash transfers or vouchers, can help overcome financial barriers to accessing maternal health services. This can encourage pregnant women to seek antenatal care, deliver at healthcare facilities, and receive postnatal care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Determine the specific population group that will be the focus of the simulation, such as pregnant women in a particular region or community.

2. Collect baseline data: Gather relevant data on the current state of access to maternal health services in the target population. This can include information on healthcare infrastructure, utilization rates of maternal health services, and barriers to access.

3. Define indicators: Identify key indicators that will be used to measure the impact of the recommendations on improving access to maternal health. This can include indicators such as the percentage of pregnant women receiving antenatal care, the percentage of deliveries at healthcare facilities, and the percentage of postnatal care visits.

4. Develop a simulation model: Create a simulation model that incorporates the recommendations and their potential impact on the defined indicators. This can involve using statistical modeling techniques or simulation software to estimate the changes in access to maternal health services based on the proposed interventions.

5. Validate the model: Validate the simulation model by comparing its outputs with real-world data or expert opinions. This can help ensure the accuracy and reliability of the simulation results.

6. Run simulations: Run multiple simulations using different scenarios and assumptions to assess the potential impact of the recommendations on improving access to maternal health. This can involve varying parameters such as the coverage of interventions, the population size, and the timeframe of implementation.

7. Analyze results: Analyze the simulation results to determine the projected changes in access to maternal health services. This can include quantifying the improvements in the defined indicators and identifying any potential challenges or limitations of the recommendations.

8. Communicate findings: Present the findings of the simulation study to relevant stakeholders, such as policymakers, healthcare providers, and community leaders. This can help inform decision-making and prioritize interventions that have the greatest potential for improving access to maternal health.

It is important to note that the methodology for simulating the impact of recommendations on improving access to maternal health may vary depending on the specific context and available data.

Authors & Co-Authors

Statistics:

Authors: 5

Identifiers:

DOI: 10.1038/s41598-022-25064-x

Research Areas:

Environmental, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

South Africa

Study Design:

Cohort Study, Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female