CD07-005, Translating Research into the Jade Ribbon Campaign

描述（由申请方提供）：在及时识别和免疫B型肝炎病毒（HBV）感染妇女所生婴儿方面存在重大差距。及时识别这些新生儿至关重要，因为出生时的免疫预防可以防止超过90%的新生儿传播HBV。相比之下，超过90%的感染HBV的新生儿将发展为慢性B型肝炎，这使得肝癌的风险增加200倍。为了解决这一关键的公共卫生问题，免疫实践咨询委员会（ACIP）于2005年发布了建议，以改善全国范围内对围产期HBV传播的预防。广泛采用这些准则的下一步是将其转化为公共卫生战略，促进迅速采取建议的行动。因此，本研究项目旨在了解阻碍或促进采用围产期B型肝炎预防指南的因素，并将ACIP建议转化为针对感染HBV的孕妇、新生儿以及其他家庭和性接触者的预防服务的具体实施。我们的具体目标如下：1）及时提供产前报告的孕妇感染HBV的产科医生人数至少增加300%; 2）病例管理服务中新生儿暴露登记人数至少增加10%; 3）将新生儿暴露疫苗接种后血清学检测率提高到80%以上;（4）将采用标准化程序管理乙肝病毒阳性孕妇、新生儿及其家庭和性接触者的分娩医院比例提高到75%以上;（5）提高乙肝病毒阳性孕妇对B肝炎的认识。我们的项目将在两个加州县，其中至少有四分之一的人口是由亚洲和太平洋岛民美国人-在围产期HBV传播的风险最高的种族/民族群体。我们的战略重点是通过传播符合文化特点的教育材料，对保健提供者、孕妇及其家庭接触者进行教育;提供标准化的“HBsAg阳性孕妇提供者资料包”，以便利医院工作人员采用病例报告和管理准则;以及为感染乙肝病毒的孕妇提供信息支持。我们将评估干预前和干预后的做法，知识，以及利益相关者之间的障碍和促进因素，并将评估我们干预的成本效益，以解决其未来的可持续性。我们研究的最终目标是制定一个全面的围产期B型肝炎预防计划，该计划可以广泛传播，并无缝集成到现有的公共卫生服务计划中，从而形成一个更有效，高效和可持续的战略，长期减少B型肝炎引起的疾病和死亡。

DESCRIPTION (provided by the applicant): Major gaps exist in the timely identification and immunization of infants born to women infected with hepatitis B virus (HBV). Timely identification of such newborns is critical because immunoprophylaxis at birth can prevent HBV transmission in over 90% of newborns. In contrast, more than 90% of newborns infected with HBV will develop chronic hepatitis B, which confers a 200-fold increased risk of liver cancer. To address this critical public health issue, the Advisory Committee on Immunization Practices (ACIP) issued recommendations in 2005 to improve nationwide prevention of perinatal HBV transmission. The next step in the widespread adoption of these guidelines is to translate them into a public health strategy that fosters rapid uptake of the recommended actions. Therefore, this research project aims both to understand the factors that impede or facilitate the adoption of perinatal hepatitis B prevention guidelines, and to translate the ACIP recommendations into concrete implementation of prevention services for pregnant women infected with HBV, their newborn infants, and other household and sexual contacts. Our specific aims are as follows: 1) to increase by at least 300% the number of obstetricians that provide timely antenatal reporting of pregnant women infected with HBV; 2) to increase by at least 10% the enrollment of exposed newborns in case management services; 3) to improve to over 80% the rate of post-vaccination serologic testing among exposed newborns; 4) to increase to over 75% the proportion of delivery hospitals that adopt standardized procedures for management of HBV-positive pregnant women, their newborns, and their household and sexual contacts; and 5) to improve knowledge about hepatitis B among HBV-positive pregnant women. Our project will be based in two California counties where at least one-quarter of the population is composed of Asian and Pacific Islander Americans-the racial/ethnic group at highest risk of perinatal HBV transmission. Our strategy focuses on education of health care providers, pregnant women, and their household contacts through the dissemination of culturally tailored educational materials; provision of standardized "provider packet for HBsAg positive pregnant women" to facilitate the adoption of case reporting and management guidelines by hospital personnel; and informational support for pregnant women infected with HBV. We will assess pre- and post-intervention practices, knowledge, and barriers and facilitators to care among stakeholders, and will evaluate the cost effectiveness of our intervention to address its future sustainability. The ultimate goal of our study is to develop a comprehensive program for perinatal hepatitis B prevention that can be disseminated widely and integrated seamlessly into existing public health service programs to result in a more effective, efficient, and sustainable strategy for long-term reduction of disease and death due to hepatitis B.