BACKGROUND: Historically, the Philadelphia Department of Public Health (PDPH)’s primary method of identifying HBV-positive pregnant women required staff to call individual providers and/or women to assess pregnancy status at the time of a positive HBV-test. Since 2014, PDPH’s Perinatal Hepatitis B Prevention Program (PHBPP) has used the CDC-spearheaded initiative, Laboratory Reporting Pregnancy Status (LRPS), which entails bulk review of HL7 messages using key terms, to enhance the historic method of identifying at-risk mother-infant pairs for PHBPP case management. Since implementation, a major Philadelphia reference laboratory (RL) has routinely delivered HL7 messages of recently tested hepatitis B (HBV)-positive pregnant women. This study compares the efficacy and timeliness of LRPS from RL to the historic method used to identify HBV-positive pregnant women.
METHODS: PHBPP surveillance data containing administrative tracking, laboratory, and case management information from 2014 – 2016 was used. Mothers with a positive HBV test reported by RL were included. Mean time from initiation of pregnancy investigation to identification of pregnancy status was compared between the historic and LRPS methods of identifying HBV-positive pregnant women. Sensitivity measures were retrospectively calculated to ascertain the number of pregnant women identified using both methods. Challenges with each methodology were also assessed and compared.
RESULTS: During the study period, reports for 1,299 HBV-positive women were received from RL. Of these, 160 (12%) were identified as pregnant, representing 44% (160/367) of total pregnancies PHBPP followed. The historic method of assessing pregnancy status reviewed all of the RL reports, and identified 2% (25) as pregnant. Of the RL pregnancies, 11 (7%) had no HL7 indication of pregnancy, thus LRPS has a true sensitivity of 93.1%. On average, LRPS and historic methods identified HBV-positive pregnant mothers 118 and 9 days before delivery, respectively. Mean time to pregnancy status ascertainment was 14 days using LRPS and 74 days using historic methods.
CONCLUSIONS: LRPS is a cost-effective, efficient, and highly sensitive method for identifying HBV-infected pregnant women. By identifying women earlier in pregnancy, LPRS allows for more effective PHBPP case management than historic methods used by PDPH. Health Departments should consider using LRPS to identify HBV-infected pregnant women for follow-up, thereby freeing up human resources for additional perinatal HBV prevention and case management activities.