Hrev_master Healthcare in Low-resource Settings 2024; volume 12:12072 Behavioral prevention of HBV transmission in urban communities toward global elimination of hepatitis in 2030: a systematic review Fiya Diniarti,1,2 Mohamed Saifulaman Mohamed Said,2 Norhashima Abd Rashid,2 Sandeep Poddar2 1Public Health Programe, Faculty of Health Sciences, Universitas Dehasen Bengkulu, Bengkulu, Indonesia; 2Lincoln University College, Wisma Lincoln, Selangor, Malaysia Abstract Hepatitis B is a serious threat to public health on a global scale. The Hepatitis B virus (HBV), which spreads both vertically and horizontally, is easily contracted by anyone. In 2020, the World Health Organization estimates that 257 million people worldwide have hepatitis B, and 900,000 people die from it each year. According to the World Health Organization (2021), there are approximately 39.4 million people in Southeast Asia living with chronic hepatitis B mortality, with 410,000 deaths caused by the disease. HBV can spread through injections, horizontal trans- mission, blood transfusions, and organ transplants. Cochrane, Science Direct, PubMed, Elsevier, Sage, Willey, DOAJ, and Google Scholar database sources were used to search for support- ed research on how to prevent hepatitis virus transmission in urban communities. 15 publications address the primary and sec- ondary prevention of hepatitis B transmission in urban settings. Prevention keeps a person in good health and prevents them from progressing to a later, worse stage. Given that the hepatitis B virus can infect anyone, regardless of age, and that it affects people’s health worldwide, as well as their families, communities, and fam- ilies within them. In order to eradicate the hepatitis B virus, soci- ety must be aware of the importance of implementing preventive measures on a continuous and long-term basis through health advocacy activities, hepatitis B virus screening campaigns, health education, counseling, hepatitis B vaccination with community- based activities, and secondary prevention through combination therapy treatment in post-liver transplant patients. Introduction Hepatitis B transmission can happen both vertically and hor- izontally, making it a serious threat to public health on a world- wide scale.1 A virus called hepatitis affects the liver. Everyone can readily contract the hepatitis B virus (HBV), which spreads both vertically and horizontally.2 Hepatitis B virus transmission can happen during childbirth (from an infected mother to her child), prior to sexual contact with a sick partner, while sharing items like razors or toothbrushes, when coming into direct con- tact with blood or exposed wounds of a contaminated person, or when an infected person spills blood. Needles and sharps from diseased individuals, as well as those used by those getting tat- toos or body piercings using non-sterile instruments (from infect- ed people).3 About 328 million people around the world are con- stantly sick with HBV, and most of them have not been identified or treated.4 The World Health Organization (WHO) aims to reach 80% treatment coverage and 90% vaccine coverage by 2030.5,6 According to the RISKESDAS7 results from 2018, Indonesia shows the prevalence of hepatitis based on a doctor’s diagnosis history, with differences between provinces of 0.18% (Bangka Belitung Islands) and 0.66% (Papua). Hepatitis spreads almost evenly across all age groups, genders, educational levels, occupa- tions, and places of residence. The national program for the pre- vention and control of the virus currently emphasizes keeping mother to child transfer from occurring because infants are in danger of developing hepatitis B virus that persist in their moth- ers who have the virus (PPIA).8 To address this disease globally, public health recommendations and initiatives have been devel- oped concurrently.9 One of the tactics used is raising awareness of the hepatitis B virus defense mechanism among people, fami- lies, and communities in order to bring about changes in urban communities’ behavior.10 Correspondence: Correspondence: Fiya Diniarti, Universitas Dehasen Bengkulu, Jl. Meranti No.32, Sawah Lebar, Kec. Ratu Agung, Kota Bengkulu, Bengkulu 38228, Indonesia E-mail: Fiyadiniarti@unived.ac.id Key words: urban society; preventive behavior; hepatitis B. Contributions: FD, conceptualization or design of the work, method- ology, writing - original draft; MSMS, drafting the work or review- ing it critically, supervision; NAR, drafting the work or reviewing it critically, supervision; SD, project administration, review & editing. Conflict of interest: the authors declare no potential conflict of inter- est, and all authors confirm accuracy. Ethics approval and informed consent: not applicable. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Received: 12 November 2023. Accepted: 13 March 2024. Early view: 16 April 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:12072 doi:10.4081/hls.2024.12072 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2024;12:12072] [page 315] Non -co mmerc ial us e o nly Materials and Methods With the terms “Prevention” and “Hepatitis B,” this systematic review search uses science direct to get data from sites like PubMed, DOAJ, Cochrane, Sage, Willey, Elsevier, and Google Scholar. The requirements were: research publications with titles and contents that match the study’s goals; research subjects with a possible hepatitis B infection; English; written between 2010 and 2022. The article does not have a comprehensive structure, accord- ing to the exclusion criteria. The following actions are taken as part of a systematic review using Prism guidelines: find articles that include manually chosen and recorded keywords; conduct screen- ing in accordance with established inclusion and exclusion criteria; conduct article analysis utilizing the Joanna Bringgs Institute. Based on the findings of a literature search conducted using eight online databases, 500 articles were found. These were then filtered from the database selection to 53 articles, and 33 eligible articles were found after examining titles, reading abstracts, background suitability, research objectives, research methods, and results. After reading the full text, 15 articles were eliminated, leaving 10 for examination. Results The prevention of suspected hepatitis B in rural and urban areas is examined in this research. The literature under examina- tion is a true investigation, not a critique, and includes the next: author name, research design, and sample size (Figure 1; Supplementary materials, Table 1). These 15 articles discuss findings about preventative behavior (primary and secondary hepatitis B virus transmission in urban communities) based on the results of article analysis. The twelve articles demonstrate that primary prevention is a collective effort that begins in the stage of optimum health and does not move into a stage that could exacerbate the condition. Actions must be taken prior to the infection of the hepatitis B virus and include aspects of health promotion and protection. According to this article, the pri- mary prevention focuses on promoting health (improving health) through health advocacy, hepatitis B virus screening campaigns, health education, and counseling to increase community knowl- edge and awareness starting with individuals, families, and com- munity groups as well as focusing on general and specific protec- tion through immunization, insurance, and Hepatitis B immuniza- tion. protection both specifically and generally. Three articles show that communities, families, or individuals are responsible for pri- mary prevention. Those who are ill are identified early and receive immediate care through appropriate care. This article focuses on the use of lamivudine (LAM) combination therapy with nucleoside analogue (LAM) to HBIG to treat HBV patients after orthotopic liver transplantation (OLT) to increase patient life expectancy and the use of antiviral and immunoprophylactic drugs for expectant mothers with chronic the hepatitis B virus during pregnancy, espe- cially in reducing the amount of virus and providing protection. The study identified several risk factors for hepatitis B, including age (45 years and older), gender (male), having a mother who was infected, and a history of blood transfusions. Discussion Anyone at any age can contract the hepatitis B virus. HBV attacks the liver. Serological evidence of previous or present viral hepatitis B is present in about one-third of the worlds population (HBV). When HBsAg-positive body fluids from people who have an acute or chronic HBV infection are exposed through parenteral or mucosal routes, the virus is passed on. It reproduces in hepato- cytes using a specific reverse transcription method. Percutaneous inoculation, horizontal transmission, blood transfusion, organ transplantation, and post-exposure prophylaxis are all ways that HBV spreads (Figure 2).25,27 Based on data from the WHO 2021 (Figure 3),28 the highest number of fresh cases hepatitis B infection cases has the Africa region (990,000 cases). And the greatest quan- tity of deaths the western pacific (470,000 cases). Primary and sec- ondary prevention strategies that continuously and sustainably raise awareness among individuals, families, and communities aim to lessen the danger of the virus that causes hepatitis B. The fact is that despite the implementation of this strategy in both developed and developing nations, hepatitis B morbidity and mortality remain a problem in the world due to changes in people’s behavior caused by a variety of factors, including age, gender, education, socio-cul- ture, the economy, health services, and stakeholders policy.29 Review Figure 1. Literature search strategy. Figure 2. Goals for lowering the number of new cases and deaths caused by chronic hepatitis B and C viruses. Source: World Health Organization. Global Health Sector Strategies on Viral Hepatitis 2016-2021.27 [page 316] [Healthcare in Low-resource Settings 2024;12:12072] Non -co mmerc ial us e o nly Based on Graphic 3, the average hepatitis B infection is mostly on female with the age 20-45 years.30 Based on Figure 4, it shows that the average risk factors that can cause Acute Hepatitis B are through heterosexual transmission, nosocomial, sex between men and chronic hepatitis transmitted through mother to child transmis- sion.30 Health education is used as the primary method of prevent- ing the spread of Hepatitis B (health promotion). Risk factors for infectious diseases can be described through the theory of the epi- demiological triangle. The epidemiological triangle is a model that has been developed to see health problems (infectious diseases), the epidemiological triangle has three angles (agent, host and envi- ronment).31 Risk factors for hepatitis B are socio-demographic, behavioral, medical, middle age, male, married, rural living, low education, smoking, having positive household contacts of HBsAg, family history of HBV, history of surgery or blood trans- fusion.32 According to Maamor et al. research from 2022,24 she dis- covered that seven studies (46.7%) and eight (53.3%) reported average and good knowledge, respectively. Study two (40%) in Asia is having strong knowledges, one’s (20.0%) had average knowledge, and two (40%) inadequate knowledge.22 According to research, community-based screening, advocacy, and hepatitis B health education initiatives are effective primary prevention tac- tics. they can be quite helpful in persuading HBV-infected people to use public health resources.33,34 Research findings in Indonesia found that the lack of information about the transmission of hep- atitis B infection affects hepatitis B prevention behavior in an effort to support the vaccination program, obstacles to the vaccina- tion program (vaccination campaign) caused by the high cost of vaccination, lack of vaccine availability in certain areas, and limit- ed human resources to carry out the hepatitis B vaccination pro- gram.35 This study supports the recommendation that the WHO states that all babies should receive the vaccine for hepatitis B as soon as possible after birth, ideally within 24 hours, and then the next doses should be spaced at least 4 weeks apart. The vaccine’s purpose is to provide the general public with lifelong protection, or at least 20 years of it.36 The WHO recommends using antiviral pro- phylaxis in addition to baby vaccination to stop the spread of hep- atitis B from mother to child. Utilizing safer sex techniques, such as limiting the number of partners and using condoms, as well as blood safety strategies lowers transmission.37,38 In order to meet the 2030 Sustainable Development Agenda’s global hepatitis elimina- tion target, preventive efforts are being made. These efforts include raising awareness, encouraging resource mobilization, developing evidence-based data policies for action, and improving health equi- ty in hepatitis response.21,24 The results of the study in Bangladesh reported that Bangladesh has a medium low prevalence rate of HBV infection (4.0%), a prevalence rate that represents explaining the incidence prevalence and epidemiology of hepatitis B and can be beneficial for public health leaders for policy making. This study aims to improve understanding of the epidemiological identification of HBV in Bangladesh, reduce the risk of hepatitis B in Bangladesh, and increase the coverage of the national immunization program to ensure vaccination of people at all levels.39 Each year the preva- lence of liver cancer ranged (4.5%) and cirrhosis hepatis ranged (5.8%) and other liver diseases, including nonalcoholic fatty liver disease/ hepatic steatosis 2016 (4.1%), alcoholic liver disease/alco- holic cirrhosis/alcoholic hepatitis around 2016 in (0.45%).40 The prevalence of hepatitis B continued to decline after the introduc- tion of hepatitis B vaccination, but the disease remains a signifi- cant public health problem worldwide. This study summarizes the most important recommendation trends for preventing hepatitis B are screening in pregnant women, CHB screening, maternal HBeAg, HBV viral load, ALT level and HbsAg level, and antiviral administration for two main purposes: Vertical treatment and pre- vention, during pregnancy Tenofovir is administered, a combina- tion of the HBIG and hepatitis B vaccines within the first 12 hours to all babies born to mothers with CHB.41 The gap in hepatitis B elimination globally is widespread. Many countries have achieved an important target of HBsAg seroprevalence of <0.1% in children under 5 years of age. Lack of knowledge about hepatitis B in women in Thailand can be increased through preventive education by providing counseling about hepatitis B vaccination, the coun- seling process can run effectively carried out by the Thai govern- ment is to train counselors, so that counseling runs interactively, then counselors in providing counseling can be appropriate visual aids in the antenatal period.42 Mother-to-child hepatitis B preven- tion program conducted in Cambodia for pregnant women by pro- viding hepatitis B vaccination and hepatitis B screening during pregnancy.43 Children who have been given doses of HBV vaccine have no risk of HBV infection in the future, HBV vaccine is the only guarantee to protect children and prevent the spread of the Review Figure 3. Acute Hepatitis B Cases Reported at High Rate. Source: Hepatitis B Annual Epidemiological Report for 2021.30 Figure 4. Transmission category of hepatitis B cases by acute and chronic disease status, EU/EEA, 2021. Sources: Hepatitis B Annual Epidemiological Report for 2021.30 [Healthcare in Low-resource Settings 2024;12:12072] [page 317] Non -co mmerc ial us e o nly virus in the community. In addition, strengthening awareness, monitoring, and implementation of existing infection control pro- cedures and increasing the coverage of hepatitis B vaccination will further reduce the prevalence of hepatitis B.44 Hepatitis B virus infection remains a public health challenge for women with a pos- sible risk of vertical transmission to their babies in the study area. Routine screening recommendations for the hepatitis B virus in pregnancy.45 The prevalence of HV is very low in pregnant women not living with HIV.46 There is a significant relationship between the level of RPR (rapid plasma regain examination) and the degree of liver fibrosis based on TE (fibro scan) in chronic hepatitis B patients, then RPR can be used as a non-invasive diagnostic mark- er to predict severe fibrosis in chronic hepatitis B patients, with a cut-off point of 0.0538 with sensitivity of 76% and a specificity of 63%.47 Research findings in Vietnam illustrate that Vietnam is an area of intermediate endemicity of hepatitis B. To combat HBV in Vietnam prevention of hepatitis B from mother to child is carried out through a hepatitis B vaccination policy after the baby is born and immunization coverage must be complete, for incomplete immunization coverage in children will be monitored by health workers.48 Early human preterm birth (PTB) is a risk factor for HBV infection alone, and HBV DNA levels do not appear to have an impact on the risk . A comprehensive program focusing on preg- nant women with HBV infection will reduce the incidence of adverse outcomes.49 Indonesia is an area of high endemicity and is included in the high prevalence of hepatitis B, which is more than 8%. Prevention efforts are carried out through hepatitis B screen- ing in pregnant women, the screening is carried out at Puskesmas.50 Risk factors for hepatitis B are parity, low education, history of sexual partners >1, use of non-sterile syringes, family history of hepatitis B. The Singapore study analyzed that the government subsidizes antiviral treatment to reduce perinatal transmission. If hepatitis B cases increase in Singapore, future generations will contract hepatitis B infection and eventually become a burden on the state. Screening and treatment activities are carried out for infected mothers at a cost that is affordable to the community.51 According to research in Vietnam, the comparison of pregnant women with umbilical cord blood diagnosed with HBsAg positive and negative found that pregnant women who have HBsAG posi- tive umbilical cord blood are at risk of transmitting hepatitis B from mother to child (from mother to child).52 The impact of preg- nant women who are positive for chronic hepatitis B has the risk of premature birth premature rupture of membranes, heavy bleeding, gestational diabetes and fetal death. Gestational diabetes is dia- betes that occurs directly during pregnancy until the delivery pro- cess, the condition generally occurs in the second or third trimester.53 Primary prevention efforts (education, campaigns, screening, early detection, and vaccination) are very important in reducing the risk of mother-to-child transmission for all people in the world. The community must work together with the govern- ment to support the SDGs program in reducing the prevalence of hepatitis B.54 Conclusions The preventive behavior of urban communities in supporting global elimination in 2030 includes primary and secondary preven- tion. Primary prevention (health promotion) includes health advo- cacy, hepatitis B virus screening campaigns, health education, community-based counseling and the condom use. 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Singapore Med J 2020;61:24. 52. Hoang TT, Bui TT, Pham TT, et al. Study the correlation between the mother-to-child transmission risk factors in chron- ic hepatitis B virus infection pregnant women in vietnam by HCA method. Available from: https://doi.org/10.20944/ preprints202208.0292.v1 53. Sirilert S, Tongsong T. Hepatitis B virus infection in pregnan- cy: immunological response, natural course and pregnancy outcomes. J Clin Medi 2021;10:2926. 54. Rajamoorthy Y, Taib NM, Mudatsir M, et al. Risk behaviours related to hepatitis B virus infection among adults in Malaysia: A cross-sectional household survey. Clin Epidemiol Global Health 2020;8:76-82. Review [page 320] [Healthcare in Low-resource Settings 2024;12:12072] Online supplementary material: Table 1. Lists the result from a systematic review search (n=15). Non -co mmerc ial us e o nly