Transmission from infected mothers to their newborns is a major concern hindering elimination of hepatitis B as a public health threat in Indonesia. Mother-to-child transmission (MTCT) of the virus during childbirth often results in chronic infection for the infants, who are at significant risk of developing chronic hepatitis B that may lead to severe liver-related complications later in life. Limited awareness, limited healthcare resources, and regional disparities exacerbate this challenge.
Hepatitis B, a virus attacking the liver, affects millions of people worldwide. According to the nationwide Basic Health Research (Riskesdas), hepatitis B surface antigen (HBsAg) is found in 7.1% of the population, or around 18 million Indonesians. While universal infant hepatitis B immunization programmes have contributed to a reduction in hepatitis B virus infection, infection persists among young children, evident in a 4.2% prevalence of HBsAg among children under the age of five years. To address this, WHO supports the Ministry of Health (MoH) to eliminate MTCT by incorporating prophylaxis to reduce the risk of infection.
This support included guideline development and calculation of needed reagents, prophylaxis, and equipment to be distributed to provinces. In addition, WHO facilitated trainings and conducted field visits to monitor the implementation of interventions.
| Capacity building on antiviral prophylaxis in pregnant women in Boalemo District. Credit: Boalemo District Health Office |
Indonesia utilised rapid diagnostic tests for the pregnant mothers to confirm their hepatitis B status. The pregnant women with confirmed hepatitis B then received tenofovir, the prophylaxis used in this intervention. To improve accessibility, the MoH integrated Tenofovir into the Puskesmas tuberculosis programme by means of point-of-care testing (POCT) for hepatitis B virus DNA viral load.
As of 2023, this initiative has been implemented in 34 districts in 17 provinces, spanning 43 hospitals and 137 primary healthcare centres (Puskesmas). More than 300 pregnant women with hepatitis B have received access to antiviral medication, protecting their babies from being infected.
In pursuit of hepatitis reduction, MoH in collaboration with WHO Indonesia established a comprehensive roadmap for antiviral prophylaxis. The objective is that by 2029 every health facility offers antiviral prophylaxis.Dr Ratna Budihapsari, Head of the MoH Hepatitis Working Group, remarked, “Tenofovir prophylaxis is at the forefront of our efforts to eliminate hepatitis B transmission from mothers to their children. The Ministry of Health is committed to provide accessible and effective interventions, working tirelessly towards a future where no child is born with hepatitis B.”
The MoH Working Group for Hepatitis, East Nusa Tenggara PHO, Kupang City DHO, and Sikumana Puskesmas staff discussing antiviral prophylaxis. Credit: MoH/Working Group for Hepatitis
The effectiveness of antiviral prophylaxis in reducing maternal viral load and its safety profile during pregnancy make it a reliable, evidence-based choice to protect both maternal and infant health. By safeguarding the newborn from hepatitis B infection at birth, antiviral prophylaxis not only counteracts immediate health risks but potentially reduces the long-term burden of hepatitis B-related diseases, aligning with broader public health objectives.
In line with the roadmap, all districts in the archipelago will screen pregnant women for hepatitis B. The launch in 34 districts serves as a model to bring screening and treatment closer to pregnant women at the primary healthcare level. WHO Indonesia will continue its support in ensuring that the intervention successfully prevents MTCT of hepatitis B as well as monitoring the health of mothers and infants throughout the process. Regular and comprehensive follow-up care is essential to achieving the programme’s goals and reducing the long-term burden of hepatitis B in Indonesia. WHO Indonesia will support in studying the implementation of antiviral prophylaxis in several districts in 2024–2025.
Written by Nurhayati Kawi, National Consultant for Hepatitis; and Resita Dyah Purnama Suci, Hepatitis Program Data Assistant; WHO Indonesia