CD07-005, Translating Research into the Jade Ribbon Campaign

描述（由申请人提供）：在感染乙型肝炎病毒（HBV）的妇女所生婴儿的及时识别和免疫方面存在重大差距。及时发现这类新生儿至关重要，因为出生时进行免疫预防可在90%以上的新生儿中预防HBV传播。相比之下，90%以上感染乙肝病毒的新生儿会发展为慢性乙型肝炎，这使肝癌的风险增加200倍。为了解决这一重要的公共卫生问题，免疫实践咨询委员会（ACIP）于2005年发布了建议，以改善全国围产期乙型肝炎病毒传播的预防。广泛采用这些准则的下一步是将其转化为一项公共卫生战略，促进迅速采纳所建议的行动。因此，本研究项目旨在了解阻碍或促进围产期乙型肝炎预防指南采用的因素，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)将提供乙肝病毒感染孕妇产前及时报告的产科医生人数至少增加300%；2)将接受病例管理服务的暴露新生儿人数增加至少10%；3)将暴露新生儿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hbv阳性孕妇、新生儿及其家庭和性接触的接生医院比例提高到75%以上；5)提高乙肝病毒阳性孕妇的乙肝知识。我们的项目将在加州的两个县开展，这两个县至少有四分之一的人口是由亚裔和太平洋岛民组成的，他们是围产期HBV传播风险最高的种族/族裔群体。我们的战略侧重于通过传播适合不同文化的教育材料，对保健提供者、孕妇及其家庭联系人进行教育；提供标准化的“乙肝表面抗原阳性孕妇提供者包”，以促进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、利益相关者之间的障碍和促进因素，并将评估干预措施的成本效益，以解决其未来的可持续性问题。我们研究的最终目标是制定一个围产期乙型肝炎预防的综合计划，该计划可以广泛传播并无缝整合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，以长期减少乙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.