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Doctor with pregnant lady in a doctor's surgery

Czas czytania: 3 min

17 września 2026

ZDROWIE SPOŁECZNOŚCI I ZDROWIE GLOBALNE

Artykuł

When every day counts: Lessons from decentralized HBV testing in Mali

A study from Mali highlights how decentralized HBV viral load testing can bring critical answers closer to expectant mothers and their care teams.

 

A pregnant woman comes in for her usual antenatal care visit. She accepts testing, follows her doctor's advice, and does everything every health care system wishes expectant mothers would do.

Then comes a question that could shape her child's future.

If she is living with hepatitis B, can transmission to her baby still be prevented?

The answer often depends on a viral load test. Yet for many women across sub-Saharan Africa, access to HBV DNA testing remains limited because testing is frequently performed far from where care is delivered. Samples travel to centralized laboratories, and results can take days or weeks to return, potentially delaying clinical decision-making.1.2

A recent study conducted in Mali explored whether bringing HBV viral load testing closer to patients could help address this challenge. The findings tell a story not only about diagnostics, but about the importance of timing in preventing mother-to-child transmission of hepatitis B.3

 

The challenge behind a positive test

Hepatitis B remains a major public health challenge worldwide. An estimated 254 million people are living with chronic HBV infection, and Africa accounts for nearly two-thirds of new infections globally.1 Mother-to-child transmission continues to be one of the most important sources of new infections, making pregnancy a critical opportunity for intervention.2, 3

Fortunately, prevention is possible.

The World Health Organization recommends antiviral prophylaxis for pregnant women with HBV DNA levels of 200 000 IU/mL or higher to help reduce the risk of transmission during childbirth.3  But, before treatment decisions can be made, clinicians need access to viral load information.

That is where many healthcare systems face a challenge.

In Mali, researchers screened 2 952 pregnant women attending antenatal care services across different regions of the country. Among them, 205 women tested positive for hepatitis B surface antigen (HBsAg), corresponding to a prevalence of 6.9%, confirming that hepatitis B remains highly endemic among pregnant women. 4

The study also revealed another concern. More than half of HBsAg-positive women (57,6%) were unaware of their hepatitis B status before screening, while hepatitis B vaccination coverage was just 1.0%.4

For many women, pregnancy remains the first time hepatitis B enters the healthcare conversation.

 

Not every positive result tells the same story

A positive hepatitis B screening result does not automatically mean a mother faces a high risk of transmitting the virus to her baby.

That is why viral load testing plays such an important role.

Among the 191 women who underwent HBV viral load testing using the Xpert® HBV Viral Load assay, 64% had detectable HBV DNA. Most had viral loads below 2 000 IU/mL (69,9%), while 24,4% had viral loads between 2 000 and 200 000 IU/mL.4

A smaller but critically important group had viral loads above 200 000 IU/mL, the threshold associated with increased risk of mother-to-child transmission and eligibility for antiviral prophylaxis. These women represented 5.7% of those with detectable viral loads and 3.9% of all HBsAg-positive women included in the study.4

At first glance, that may seem like a small number.

Every one of those women represents an opportunity for interventions designed to reduce the risk of mother-to-child transmission.

The study also highlighted a significant treatment gap. Among women with viral loads above 200 000 IU/mL, only 57,1% were receiving antiviral therapy at the time of testing.4

The challenge, therefore, is not only identifying risk. It is ensuring that high-risk mothers are identified early enough and connected to care quickly enough to act.

 

Bringing answers closer to care

Researchers wanted to understand whether decentralizing HBV viral load testing could help close that gap.

Instead of relying exclusively on centralized laboratories, some samples were tested in peripheral facilities equipped with GeneXpert® systems already available within the healthcare network.4

The results were encouraging.

Women whose samples were analyzed in decentralized laboratories were substantially more likely to receive results within one day. Same-day results were available for 23,5% of decentralized tests compared with just 4.4% of tests processed through the central laboratory, representing an approximately five-fold improvement.4

For expectant mothers approaching delivery, earlier results may support more timely treatment decisions and care planning.4

Yet the study also offers an important reality check.

Despite improved access to same-day testing, most results in both decentralized and centralized settings were delivered after more than four days. Researchers identified workload constraints, logistics, sample management processes, and result communication systems as key contributors to these delays.1

The study suggests that improving access to diagnostics alone may not fully address delays in result delivery.

 

Looking beyond the test

The Mali study is ultimately not just a story about diagnostics. It is a story about timing and better access and health outcomes for pregnant women and their unborn child.

As countries work toward eliminating mother-to-child transmission of hepatitis B, success will depend on more than screening programs alone. It will require timely viral load testing, rapid access to treatment when indicated, and strong systems capable of turning information into action.2, 3

The findings from Mali suggest that decentralized HBV viral load testing can help close one important gap by bringing critical information closer to where care happens.4

Because when it comes to preventing hepatitis B transmission, the question is rarely whether solutions exist.

The question is whether they reach the right mother at the right moment.

And sometimes, shortening the distance between a patient and an answer can make all the difference.

Disclaimer: The content presented on this page is intended for informational and educational purposes. While it is available globally, it may reflect clinical practices or healthcare system considerations specific to a particular region.

 

Piśmiennictwo:

1. Fofana DB, Koné M, Sissoko H, et al. Knowledge and Attitudes of Women in the Pre- and Postnatal Period on Screening and Mother-to-Child Transmission of the Hepatitis B Virus in Mali. J Community Health. 2026 Jun;51(3):436-444. doi: 10.1007/s10900-026-01557-y. Epub 2026 Mar 6.PMID: 41787234

2. Światowa Organizacja Zdrowia Global hepatitis report 2024: action for access in low- and middle-income countries. Geneva: World Health Organization; 2024. Dostęp z: WHO Global Hepatitis Report 2024

3. Światowa Organizacja Zdrowia Prevention of mother-to-child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy. Geneva: World Health Organization; 2020. Dostęp z: WHO HBV Prophylaxis Guidelines

4. Fofana DB, Diallo M, Sissoko H, et al. Decentralized point-of-care HBV viral load testing for HBsAg positive pregnant women in Mali, a prospective study. BMC Infectious Diseases. 2026. Dostęp z: View study [Decentrali...y BMC 2026 | PDF]

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