We used systematic random sampling, selecting every fifth woman on the ANC waiting line. Data collection procedures At each study site, two midwives were trained for 2 days on study procedures, facts on HBV infections and transmissions, counselling, safety issues, sample collection and transportation as well as site testing for HBsAg. On obtaining

written informed consents, kinase inhibitor Dasatinib a questionnaire was administered to every selected woman to obtain sociodemographic information including maternal age, gestation age, gravidity, occupation, marital status and highest level of education. Other information on risk factors for transmission of HBV, including a history of previous blood transfusions and a history of scarification, was also obtained. The women were then helped to immediately receive care from

the clinic staff. Participants were informed that those who tested positive for HBsAg would be called back to receive results of another test (HBeAg) to be done on their stored blood samples. They were also counselled about the hepatitis B vaccine that the study would provide to their infants at birth. The plasma-derived hepatitis B vaccine was administered to infants born to HBsAg positive mothers within 12 h of birth as recommended by the WHO.18 Each vaccine dose (0.5 mL) contained 10 pg of purified HBsAg. Laboratory procedures Trained research assistants provided pretest counselling on HBV and HIV infections. Five millilitres of blood were then drawn by venipuncture from the cubital fossa under aseptic techniques. The blood samples were immediately put into portable cold boxes with ice packs. The research assistants immediately transported samples to the laboratories at study sites to test for HBsAg (ie, at Lacor and Gulu Hospital Laboratories). In the meantime, the women were helped to obtain ANC. Results were collected back by the research assistants who provided post-test counselling and released

results to the participants on the same visit day. Blood samples positive for HBsAg from Gulu hospital were transported on the same day to the Lacor hospital laboratory, frozen at −80°C and later transferred to MBN Clinical laboratories Brefeldin_A in the capital Kampala for HBeAg testing. Testing for HBsAg was done using the Infectious Diseases ELISA kits provided by Savyon Diagnostics Ltd, Ashdod, Israel, which have a sensitivity of 99% and specificity of 96.7%. Testing for HbeAg was done using the Infectious Diseases ELISA—peroxidase conjugated kits, which have 100% sensitivity and 99.9% specificity, and inbuilt quality controls. Samples from all the participants were tested for HIV, complete blood counts (CBC), liver alanine aminotransferase (ALT), aspartate aminotransferase, and alkaline phosphatase, using an SMAC auto-analyser (Semi Micro Analyzer Computer, Technicon, USA). CBC was done with an automated analyser, Humacount 60TS. HIV tests were performed using a rapid assay for HIV antibody testing.