Protektem Pikinini Blong Yu: Preventing mother-to-child transmission of hepatitis B

The World Health Organization recommends pregnant women who have a high hepatitis B viral load receive tenofovir during pregnancy. This is to prevent their child from being infected with hepatitis B.    

The WHO recommendation requires access to viral load testing, but this test is not widely available in Vanuatu and other Pacific island countries.   

The Protektem Pikinini Blong Yu (PPBY) trial compares the effectiveness of the WHO guidelines to an alternative model of care. Under this alternative, all hepatitis B-infected pregnant women receive tenofovir. There is no requirement for viral load testing.   

Our goal is to build evidence to support a ‘treat-all’ approach that could protect thousands of newborns from hepatitis B infection.   

We are studying pregnant women in Vanuatu living with hepatitis B. Participants are placed into one of 2 groups:  

• Intervention group: Pregnant women receive antiviral treatment during pregnancy to reduce the risk of passing hepatitis B to their babies.  
• Control group: Pregnant women receive standard care, without the additional antiviral treatment.  

All infants born to participants are followed closely for the first 6 to 12 months of life. During this time we monitor whether they become infected with hepatitis B.  

Parallel studies to provide a full picture  

PPBY goes beyond a traditional clinical study. It includes several important parallel sub-studies that help us better understand how to improve hepatitis B care in resource-limited, remote island settings.  

These sub-studies include:  

• exploring knowledge and perceptions of hepatitis B among pregnant women and their families  
• assessing how acceptable and effective midwife-led care is in rural communities  
• understanding what helps or hinders pregnant women in taking hepatitis B medication (tenofovir)  
• testing educational materials designed to support hepatitis B-positive mothers  
• evaluating training resources for nurses and midwives to strengthen frontline care  
• measuring how many babies receive the hepatitis B birth dose vaccine and how many complete their full vaccination schedule.

Timeline

2023–2026.

Why it matters  

Mother-to-child transmission is a leading cause of hepatitis B infection in the Pacific. By addressing this, PPBY works toward a future where no child is born with hepatitis B. The findings from this study will inform national policy, strengthen health systems, and help protect future generations.