The TRIple Elimination Model Of Mother-to-child Transmission Program (TRI-MOM) (TRI-MOM)

Integrated Antenatal Screening for HIV, Syphilis, and Hepatitis B Virus (HBV) in Pregnant Women in Burkina Faso and The Gambia

Centre Muraz, Medical Research Council, Institut Pasteur, REVS PLUS Burkina Faso, Young Gambian Mums Fund, National AIDS Control Program Gambia

The TRI-MOM program aims to implement and evaluate a simplified (based on inexpensive rapid diagnostic tests), integrated (in governmental health facilities) and coordinated (between health care workers) strategy for the triple elimination of HIV, syphilis and HBV mother-to-child transmission (MTCT) in nine maternal and child health services, 5 in Burkina Faso and 4 in The Gambia. The TRI-MOM program has two components: an "intervention" component consisting of a pilot study to reinforce the antenatal screening and prevention of MTCT (PMTCT) capacities for the 3 targeted infections through the implementation of a simplified, integrated and coordinated strategy of triple elimination of MTCT. an "evaluation" component which will assess the impact of the TRI-MOM strategy on PMTCT services, reduction of HBV MTCT and women empowerment.

The TRI-MOM (TRIple elimination Model Of Mother-to-child transmission of HIV/Syphilis and HBV in Burkina Faso and The Gambia) program aims to implement and evaluate a simplified (based on inexpensive rapid diagnostic tests), integrated (in governmental health facilities) and coordinated (between health care workers) strategy for the triple elimination of HIV, syphilis and HBV MTCT in nine maternal and child health services, 5 in Burkina Faso and 4 in The Gambia. In The Gambia, the program will be conducted in collaboration with the national HIV, sexually transmitted infections (STI) and hepatitis programmes. The TRI-MOM program has two components: an "intervention" component consisting of a pilot study to reinforce the antenatal screening and PMTCT capacities for the 3 targeted infections through the implementation of a simplified, integrated and coordinated strategy of triple elimination of MTCT. This pilot study will be conducted in 9 selected maternities. an "evaluation" component which will assess the impact of the TRI-MOM strategy on PMTCT services, reduction of HBV MTCT and women empowerment. Intervention component : The TRI-MOM strategy includes 4 main activities: Training of healthcare professionals in charge of maternal health (nurses, midwives and doctors in charge of maternal health services) Triple screening of HIV, Syphilis and HBV by rapid diagnostic tests Assessment and treatment of women positive for any of the 3 targeted infections Raising awareness on MTCT among pregnant women visiting antenatal services and empowering women infected with at least one of the three infections Evaluation component : The TRI-MOM program will include three studies : A quantitative and qualitative cross-sectional study before and after the implementation of the strategy. A cohort study of pregnant women positive for any of the three infections. Cost and cost-effectiveness analysis.

Women attending their first postnatal visit in one of the selected maternities (no maternal age limit) will be eligible to participate in the study

The TRI-MOM strategy includes 4 main activities: Training of healthcare professionals in charge of maternal health (nurses, midwives and doctors in charge of maternal health services) Triple screening of HIV, Syphilis and HBV by rapid diagnostic tests Assessment and treatment of women positive for any of the 3 targeted infections Raising awareness on MTCT among pregnant women visiting antenatal services and empowering women infected with at least one of the three infections

Assessed cross-sectionally using a questionnaire administered to women at baseline (before the implementation of the TRI-MOM strategy)

Assessed cross-sectionally using a questionnaire administered to women at 12 months (after the implementation of the TRI-MOM strategy)

Proportion of women with a good level of knowledge (defined by a score) of the targeted infections (HIV, syphilis, and HBV) and of PMTCT

Assessed cross-sectionally using a questionnaire administered to women at baseline (before the implementation of the TRI-MOM strategy)

Proportion of women with a good level of knowledge (defined by a score) of the targeted infections (HIV, syphilis, and HBV) and of PMTCT

Assessed cross-sectionally using a questionnaire administered to women at 12 months (after the implementation of the TRI-MOM strategy)

Acceptability of the implemented strategy and PMTCT and preferences : screening refusal before the strategy implementation

Assessed cross-sectionally using a questionnaire administered to women at baseline (before the implementation of the TRI-MOM strategy)

Acceptability of the implemented strategy and PMTCT and preferences : screening refusal after the strategy implementation

Assessed cross-sectionally using a questionnaire administered to women at 12 months (after the implementation of the TRI-MOM strategy)

Acceptability of the implemented strategy and PMTCT and preferences : treatment refusal before the strategy implementation

Assessed cross-sectionally using a questionnaire administered to women at baseline (before the implementation of the TRI-MOM strategy)

Acceptability of the implemented strategy and PMTCT and preferences : treatment refusal after the strategy implementation

Assessed cross-sectionally using a questionnaire administered to women at 12 months (after the implementation of the TRI-MOM strategy)

Sensitivity of the hepatitis B core-related antigen rapid diagnostic test (HBcrAg-RDT) (PROTECT-B ancillary study)

Percentage of HBsAg-positive women with a high viral load (≥200,000 IU/mL) who are positive for HBcrAg-RDT

Percentage of HBsAg-positive women with a low viral load <200,000 IU/mL who are negative for HBcrAg-RDT

Proportion of subjects with a positive HBcrAg test result who truly have a high viral load (≥200,000 IU/mL)

Proportion of subjects with a negative HBcrAg test result who truly do not have a high viral load (≥200,000 IU/mL)

Inclusion Criteria: Women attending a postnatal visit in one of the selected maternities (no maternal age limit) Exclusion Criteria: Refusal to participate in the study Unable to provide consent