The World Health Organization (WHO) has made it clear that the rate of mother-to-child transmission of hepatitis B should be reduced to less than 2% in the goal of eliminating viral hepatitis by 2030. In order to achieve this goal, Professor Hou Jinlin's team at Nanfang Hospital of Southern Medical University launched the "Zero Mother-to-Child Transmission of Hepatitis B Project" in 2015. After 10 years of research, exploration and practice, the Little Shell project has achieved remarkable results, reducing the rate of mother-to-child transmission of hepatitis B to 0.23%, far below the standard proposed by the WHO, which is a remarkable record and an important breakthrough in the field of medicine.
In order to answer these questions, the "Dialogue and Originality" in-depth interview column of "Voice of China, the Power of Innovation - China's Original Excellent Clinical Research Exhibition" specially invited Professor Liu Zhihua, a key expert of the Little Shell Project, to conduct an exclusive interview. The content of the interview is now compiled and published for the benefit of readers.
Tribune: The "Zero Mother-to-Child Transmission of Hepatitis B" project has been going on for 10 years, could you please tell us about the original intention of this project, the results achieved and the future expectations?
Prof. Liu Zhihua: In clinical practice, we often see the great suffering caused by viral hepatitis, which not only causes patients to suffer physically and mentally, but even causes some families to fall back into poverty due to illness. As infectious disease doctors, we feel a great responsibility on our shoulders. It is in this context that the "Zero Mother-to-Child Transmission of Hepatitis B" project was formed, which aims to promote the elimination of viral hepatitis and create a "future without hepatitis B". This vision is highly aligned with international and domestic public health needs to eliminate viral hepatitis, which is why the project has been placed high on the agenda since it was proposed.
The Little Shell project was launched in 2015 with the core goal of reducing the incidence of mother-to-child transmission of hepatitis B. The germination of this idea stems from Professor Hou Jinlin's forward-looking concept - zero transmission from mother to child. As a clinician, Professor Hou not only focuses on individual treatment, but also has a public health philosophy and a global perspective. He is well aware that through the mother-to-child blockade, this key link, can effectively promote the entire process of eliminating viral hepatitis.
Guided by the implementation of scientific concepts and methods, the project identified effective measures to interrupt mother-to-child transmission of hepatitis B. On this basis, we have formulated the Clinical Management Process for Maternal and Infant Blockade of Hepatitis B (hereinafter referred to as the "Management Process") based on China's national conditions, and carried out pilot work. We hope that through these efforts, we will be able to roll out this process across the country and benefit more people living with hepatitis B.
In order to promote the implementation of the project more effectively, we have also developed the Xiaobei APP mobile phone software. This tool not only improves the efficiency of clinical management, but also improves patient compliance through functions such as doctor-patient communication, patient information collection, and health education.
The implementation of the project is divided into three phases. First, we conducted a preliminary study in 10 hospitals across the country to verify the feasibility of the "Management Process" and APP, and accumulated experience in the implementation of management, then expanded to 178 hospitals to promote it and verified its effect on a larger scale, and finally, the project was expanded to the community level to establish a hospital-community integrated management model. This stage was carried out in Bao'an District, Shenzhen, and was carried out on a larger scale after exploration and summary. After nearly 10 years of hard work, the project has achieved initial results, and Guangdong Province has begun to promote the integrated management model of hospitals and communities - E outpatient clinics throughout the province.
After 10 years of unremitting efforts, we have reduced the incidence of mother-to-child transmission of hepatitis B to 0.23%, well below the World Health Organization's standard of 2%. 0.23% is a remarkable achievement and close to our target.
In the future, we will continue to work to promote and improve this management model, with a view to promoting it on a larger scale and gradually achieving the goal of zero mother-to-child transmission of hepatitis B.
Tribune: You and your team have encountered a lot of problems in the process of promoting the Little Shell project, please tell us about this aspect.
Prof. Liu Zhihua: There were many challenges in the research process of the Little Shell project, but with the concerted efforts of the team, we were able to overcome these difficulties.
First of all, the biggest challenge we face is to transform the treatment concept, which is a difficult process. Due to the differences in treatment concepts and methods between infectious disease doctors and obstetricians, such as medication problems, delivery methods, feeding methods, etc., we need to actively seek consensus between the two disciplines to ensure the uniformity, coherence and effectiveness of treatment plans. To this end, we actively organize academic conferences, seminars and other exchange activities to build a bridge of communication between the two sides and promote mutual understanding and cooperation. Through these efforts, we reached a consensus on the treatment concept, and jointly formulated a more scientific and reasonable treatment plan, which laid a solid foundation for the successful implementation of the project.
Secondly, getting pregnant women infected with hepatitis B virus to accept our treatment concept is another major challenge we encountered. It is not easy for pregnant women to change the traditional concept of treatment, especially for pregnant women with hepatitis B to receive medication during pregnancy, and the initial resistance is still very large. There is a common belief among patients that medication should be avoided as much as possible during pregnancy. We need to patiently explain and communicate with patients to understand and recognize our treatment philosophy and methods, as well as the safety and effectiveness of drugs. Over time and with the deepening of our work, we have succeeded in gaining more acceptance of our philosophy with more patients and obstetricians.
In addition, relationship coordination was also a major challenge in the process of moving the project forward. Unlike laboratory research, the Little Shell project requires communication and cooperation with a wide range of parties, including medical institutions, government departments, and non-governmental organizations. Coordination is particularly important to ensure smooth cross-sector cooperation. In this regard, the team leader, Professor Hou Jinlin, played a crucial role, and his excellent coordination and resource integration skills successfully facilitated effective cooperation between all parties.
Tribune: What innovative methods have been adopted by the Little Shell project, and what breakthroughs have been brought to the project's research?
Prof. Liu Zhihua: In the Little Shell project, we have adopted some innovative methods, which have not only brought new breakthroughs in the management of pregnant women and newborns with hepatitis B, but also provided important support for the popularization and optimization of medical services.
First of all, we developed and introduced a mobile medical tool - Xiaobei APP. This approach makes the management of pregnant women and newborns with hepatitis B easy and efficient. Through the Xiaobei APP, we can track and record the health status of pregnant women, medication and other information in real time, providing doctors with more accurate and comprehensive data support. At the same time, it is also convenient for pregnant women to obtain medical advice and make appointments for examinations through the APP, which greatly improves the convenience and accessibility of medical services.
Secondly, we have adopted the philosophy and method of implementing science. At the heart of this approach is to make proven and effective medical practices available to more doctors and patients so that they can truly benefit. With the help of implementation science, we systematically evaluate and optimize treatment options to ensure they are most effective in practice. In addition, the implementation of science has improved the efficiency of training and advocacy efforts, making new treatments more accessible and acceptable to doctors and patients.
Finally, we propose a hospital-community integrated management model, namely "Maternal and Child Health E-Clinic". This model effectively integrates the resources of the hospital and the community to form a close-knit medical network. In this network, hospitals can give full play to their professional strengths to provide high-quality medical services to the community, and the community can act as an extension of the hospital to provide residents with more convenient and caring medical services. This management model not only improves the efficiency and quality of medical services, but also enhances patients' trust and satisfaction with the medical system.
Tribune: Could you please talk about the impact of the results of the Little Shell project on the elimination of viral hepatitis?
Prof. Zhihua Liu: First of all, it should be clear that the original intention of this project is to reduce the rate of mother-to-child transmission of hepatitis B and contribute to the eventual elimination of viral hepatitis. After years of hard work, this work has achieved remarkable results.
In terms of clinical practice, the mother-to-child transmission rate of hepatitis B has been significantly reduced after the successful implementation of the Little Shell project, which is far below the target set by WHO. This fully proves that the management model of mother-to-child transmission interruption and the clinical management process of mother-to-child interruption of hepatitis B proposed by us are scientific and effective. This innovative achievement not only provides new ideas and methods for the prevention and control of hepatitis B, but also provides reference for the prevention and control of other similar diseases.
In terms of social co-governance, our projects have had a profound impact on the prevention and control of viral hepatitis as a whole. It has promoted the implementation of viral hepatitis elimination projects in Guangdong Province and even the whole country. For example, the Guangdong provincial government has issued a document to carry out a province-wide screening and early prevention and treatment program for viral hepatitis. These actions have increased the awareness rate of the whole society and promoted the attention of all sectors of society to the elimination of viral hepatitis.
In addition, the project has also increased the attention of medical staff, whether in the infectious disease department or other related departments, to pay more attention to the prevention and control of viral hepatitis. The involvement of multidisciplinary health care workers brings us one step closer to the goal of eliminating viral hepatitis.
Tribune: Whether it is the innovation process or the innovation result, the promotion of the small shell project is very successful, what do you think is the deep-seated reason behind the success?
Prof. Liu Zhihua: The reason why our project has been so successful is supported by multiple factors.
In the mainland, the base of viral hepatitis infection is relatively large, and the harm to society and families is enormous. The Party and the government have always attached great importance to people's health, and have formulated the "Healthy China 2030 Action to Eliminate the Threat of Viral Hepatitis", which is an important guarantee for the success of the Xiaobei project.
Over the years, the mainland has always put the prevention and treatment of viral hepatitis at the core, whether it is scientific research or clinical practice, has made remarkable achievements, coupled with the increasingly frequent international cooperation and exchanges in the field of medicine, we have the strength of innovation and development.
With the advancement of globalization and informatization, it provides a broader space and more possibilities for medical innovation, and the continuous emergence of new technologies provides more means and tools for medical innovation, such as the application of artificial intelligence, big data and other technologies, which injects new vitality into medical innovation.
In addition, it is the result of the joint efforts of generations after generations. For example, Professor Luo Kangxian is a leading figure in the field of hepatitis B, and he opened the blog "Luo Kangxian's Hepatitis B Channel", which has improved the public's awareness of hepatitis prevention and control by writing and publishing popular science articles, and set an example for future generations. As a national hepatitis B expert and former chairman of the Infectious Diseases Branch of the Chinese Medical Association, Professor Hou is not only a profound academic attainment and practical experience, but also committed to promoting the elimination of viral hepatitis. He used his influence to communicate with leaders of government departments, universities, hospitals, etc., and won more support and resources for the advancement of the project.
In addition, the support of the whole society is also indispensable. As a major hepatitis B province, Guangdong Province has a particularly urgent need to eliminate viral hepatitis, and the provincial government and non-governmental organizations have all gone all out to support it. Such a mission, feelings and responsibilities make us more determined to devote ourselves to this meaningful cause.
Finally, Professor Liu Zhihua ended today's interview with a sentence from Professor Hou Jinlin: "Look up at the starry sky to see the ideal, and work hard in a down-to-earth manner." This sentence is not only a work attitude, but also a guide to action. It indicates that the Little Shell project is about to launch another attack on the goal of zero infection in hepatitis B mothers and babies. In the future, they will continue to conduct in-depth research and exploration, with a view to making more breakthroughs in the prevention and treatment of mother-to-child transmission of hepatitis B, and look forward to more brilliant achievements on this road.
Expert Profile
Professor Liu Zhihua, Chief Physician of the Liver Disease Center of Nanfang Hospital, Southern Medical University, and Doctoral Supervisor. He is currently a member of the Obstetric Infection Group of the Infectious Diseases Branch of the Chinese Medical Association, and the vice chairman of the Working Committee for Promoting the Elimination of Viral Hepatitis of the Chinese Preventive Medicine Association. He has been engaged in clinical, teaching and scientific research of viral hepatitis for a long time, and has successively presided over the National Natural Science Foundation of China and the "13th Five-Year Plan" National Science and Technology Major Special Projects (Tasks) and other projects. He has published research papers in academic journals such as Nature Medicine, J Viral Hepat, J Med Virol, J Clin Transl Hepatol as the first or corresponding author. He won two first prizes of Guangdong Provincial Science and Technology Progress Award. Responsible for the implementation of the "Zero Mother-to-Child Transmission of Hepatitis B Project" (Little Shell) project and participated in the formulation of the "Clinical Management Process for Interrupting Mother-to-Child Transmission of Hepatitis B".
Written by Tong Yanhua of China Medical Tribune and reviewed by Professor Liu Zhihua
Stay tuned
2023 China Original Excellent Clinical Research Exhibition
