Rania A. Tohme

Background/Objectives: Healthcare workers (HCWs) are at an increased risk of hepatitis B virus infection through occupational exposure, yet completion of the recommended hepatitis B vaccination schedule remains suboptimal in Kenya. We assessed vaccination completion, associated factors, motivators, and barriers among HCWs. Methods: We conducted a mixed-methods study combining a cross-sectional survey of 1614 HCWs in 178 health facilities across Kakamega, Nakuru, Mombasa, and Siaya counties with nine focus group discussions. The survey was conducted in August–September 2023 and the focus groups during June 2024–January 2025. Mixed-effects logistic regression with a random intercept for health facility was used to identify factors associated with completion of three vaccine doses, and qualitative data were analyzed thematically. Results: Among 1583 HCWs with a known vaccination status, 700 (44.2%; 95% CI: 41.8–46.7) reported completing three doses, 410 (25.9%) had received one or two doses, and 473 (29.9%) had never been vaccinated. The main motivator was self-protection (71.7%). Common barriers were vaccine unavailability (57.5%), lack of knowledge (28.8%), the vaccine not being offered on site (28.2%), and cost (17.4%). Completion was more likely among male HCWs, those working in urban areas facilities, and those with 6–10 or 11–20 years of healthcare work experience, and less likely among support staff, administrative staff, clinicians and allied health professionals than among nurses/midwives. Conclusions: Fewer than half of HCWs reported completing the three-dose hepatitis B vaccination schedule. Improving vaccine availability, reducing out-of-pocket costs, strengthening dose-reminder systems, and addressing knowledge gaps may improve completion among HCWs in the study counties.

We evaluated the cost and cost-effectiveness of alternative screening pathways during 2018–2022 within Georgia’s hepatitis C elimination program, which started in 2015. We calculated patient-level costs (2022 USD$) of hepatitis C treatment with centralized and decentralized diagnostic testing in hospitals, primary healthcare (PHC), harm reduction providers (HRP), or specialized providers (SP) from reimbursement records including the value of donated direct-acting antivirals (DAAs). We model hepatitis C case-finding, transmission, and progression over a 20-year time horizon to project cost-effectiveness of treatment for each screening pathway in terms of cost per quality adjusted life year (QALY), compared to a willingness-to-pay threshold of $1,337. Unit costs of treatment decreased from $3942–$4247 across screening pathways in 2018 to $300–$338 in 2022, primarily due to reductions in DAA costs. The cascade of care varied by screening pathway, with highest hepatitis C virus (HCV) antibody prevalence and percent linked to viremia testing among HRP and SP, while total number of patients screened was highest in hospitals. While DAA costs decreased, the cost of case finding increased during 2018–2022, with the biggest increase in hospital settings mainly due to decreasing yield. The program was not cost-effective with full DAA costs, but excluding DAA costs or using lower 2022 costs make all pathways cost-effective and SP, HRP, and PHC potentially cost-saving. Donated drugs allowed Georgia’s HCV elimination program to be cost-effective, while future programs with generic drug costs are likely to be cost-effective. Reductions in yield from hospital screening suggest that later stages of elimination programs should prioritise targeted pathways.

Background/Objectives: Healthcare workers (HCWs) are at increased risk of hepatitis B virus infection through occupational exposure, yet completion of the recommended hepatitis B vaccination schedule remains suboptimal in Kenya. We assessed vaccination completion, associated factors, motivators, and barriers among HCWs. Methods: We conducted a mixed methods study combining a cross-sectional survey of 1,614 HCWs in 178 health facilities across Kakamega, Nakuru, Mombasa, and Siaya counties with nine focus group discussions. The survey was conducted in August–September 2023 and the focus groups during June 2024–January 2025. Logistic regression was used to identify factors associated with completion of three vaccine doses, and qualitative data were analyzed thematically. Results: Among 1,583 HCWs with known vaccination status, 700 (44.2%; 95% CI: 41.8–46.7) reported completing three doses, 410 (25.9%) had received one or two doses, and 473 (29.9%) had never been vaccinated. The main motivator was self-protection (71.7%). Common barriers were vaccine unavailability (57.5%), lack of knowledge (28.8%), the vaccine not being offered on site (28.2%), and cost (17.4%). Completion was more likely among male HCWs and those working in private, urban, and referral facilities, and less likely among support staff, administrative staff, and allied health professionals than among nurses/midwives. Conclusions: Fewer than half of HCWs reported completing the three-dose hepatitis B vaccination schedule. Improving vaccine availability, reducing out-of-pocket costs, strengthening dose-reminder systems, and addressing knowledge gaps may improve completion among HCWs in Kenya.

Background: Patient and healthcare provider knowledge were previously found to be significantly associated with viral hepatitis testing in Uzbekistan. However, no survey has assessed awareness and knowledge of viral hepatitis among the general population. Methods: In 2022, we conducted a cross-sectional population-based survey among persons aged≥18 years in seven of Uzbekistan’s 14 regions representing 60% of the population. We conducted face-to-face interviews to assess hepatitis B and C awareness, knowledge, and related practices. Knowledge scores for hepatitis B and C were calculated based on the total number of correct answers. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were computed to assess factors associated with awareness and knowledge scores. Analyses were weighted. Results: Of 10,000 targeted adults, 9,066 (91%) participated in the survey. Overall, 54.7% (95% CI: 46.4–62.8) and 39.0% (95% CI: 33.0–45.4) were aware of hepatitis B and hepatitis C, respectively. Females compared to males (hepatitis B: aOR: 2.61 (95% CI: 1.91–3.56); hepatitis C: 2.15 (1.76–2.63)) and persons with higher education compared to those with technical education (hepatitis B: aOR: 1.89 (95% CI:1.32–2.71); hepatitis C: 2.30 (1.63–3.25)) had higher hepatitis B and hepatitis C awareness. The median knowledge scores for hepatitis B and hepatitis C transmission were 4.9 (IQR: 4.2–6.3) out of nine and 4.8 (IQR: 4.2–5.9) out of eight, respectively. Median knowledge scores for prevention methods were 1.7 (IQR: 1.2–2.4) and 2.3 (IQR: 0.7–2.9) out of five for hepatitis B and hepatitis C, respectively. Persons ≥50 years old compared to 18–29 years old and those with less than secondary education compared to those with technical education had lower knowledge scores for hepatitis B. Living outside of Tashkent city and being unemployed were associated with having lower knowledge scores for hepatitis C. Overall,28.8% reported having ever been tested for hepatitis B and 17.7% for hepatitis C; while 8.2% and 2.3% reported being told that they have hepatitis B and hepatitis C, respectively. Conclusions: Educational campaigns are needed to promote population awareness and address knowledge gaps to increase uptake of interventions aimed at eliminating viral hepatitis in Uzbekistan.

This report describes progress toward eliminating hepatitis B and C in the country of Georgia.

The WHO member states endorsed the goal to eliminate mother-to-child transmission (EMTCT) of hepatitis B virus (HBV) by 2030, which requires achievement of ≥ 90% coverage with timely hepatitis B birth dose (HepB-BD), three doses of the hepatitis B vaccine (HepB3), and a hepatitis B surface antigen (HBsAg) seroprevalence ≤ 0.1% in children. We assessed the progress made to achieve EMTCT of HBV in Gulf Cooperation Council (GCC) countries. Data was extracted from National Viral Hepatitis Strategic Frameworks and WHO hepatitis B vaccination coverage estimates during 2018–2022 for all GCC countries. We also reviewed the literature to summarize the prevalence of HBsAg in children. During 2018–2022, coverage with timely HepB-BD and HepB3 was > 90% in all countries. All newborns irrespective of whether parents are nationals or immigrants/expatriates receive HepB-BD and other routine immunization vaccines. Prevalence of HBsAg among children was available in three of six GCC countries; it ranged from 0% in Qatar and Saudi Arabia to 0.4% in Oman. Five countries reported screening pregnant women for HBsAg, and three provided antiviral treatment of those eligible, and hepatitis B immunoglobulin to exposed newborns. In conclusion, all GCC countries achieved hepatitis B vaccination targets and countries with available data have either achieved or are close to achieving EMTCT of HBV. Remaining countries need to implement hepatitis B serosurveys to track progress to EMTCT of HBV.

Nigeria is estimated to have the largest number of children worldwide, living with chronic hepatitis B virus (HBV) infection, the leading cause of liver cancer. Up to 90% of children infected at birth develop chronic HBV infection. A birth dose of the hepatitis B vaccine (HepB-BD) followed by at least two additional vaccine doses is recommended for prevention. This study assessed barriers and facilitators of HepB-BD administration and uptake, using structured interviews with healthcare providers and pregnant women in Adamawa and Enugu States, Nigeria. The Consolidated Framework for Implementation Sciences Research (CFIR) guided data collection and analysis. We interviewed 87 key informants (40 healthcare providers and 47 pregnant women) and created a codebook for data analysis. Codes were developed by reviewing the literature and reading a subsample of queries line-by-line. The overarching themes identified as barriers among healthcare providers were: the lack of hepatitis B knowledge, limited availability of HepB-BD to vaccination days only, misconceptions about HepB-BD vaccination, challenges in health facility staffing capacity, costs associated with vaccine transportation, and concerns related to vaccine wastage. Facilitators of timely HepB-BD vaccination included: vaccine availability, storage, and hospital births occurring during immunization days. Overarching themes identified as barriers among pregnant women were lack of hepatitis B knowledge, limited understanding of HepB-BD importance, and limited access to vaccines for births occurring outside of a health facility. Facilitators were high vaccine acceptance and willingness for their infants to receive HepB-BD if recommended by providers. Findings indicate the need for enhanced HepB-BD vaccination training for HCWs, educating pregnant women on HBV and the importance of timely HepB-BD, updating policies to enable HepB-BD administration within 24 hours of birth, expanding HepB-BD availability in public and private hospital maternity wards for all facility births, and outreach activities to reach home births.

Serological surveys provide an objective biological measure of population immunity, and tetanus serological surveys can also assess vaccination coverage. We undertook a national assessment of immunity to tetanus and diphtheria among Nigerian children aged p < 0.001). Full seroprotection (≥0.1 IU/mL) was the same for tetanus (42.2%) and diphtheria (41.7%), while long-term seroprotection (≥1 IU/mL) was 15.1% for tetanus and 6.0% for diphtheria. Full- and long-term seroprotection were higher in boys compared to girls (p < 0.001). Achieving high infant vaccination coverage by targeting specific geographic areas and socio-economic groups and introducing tetanus and diphtheria booster doses in childhood and adolescence are needed to achieve lifelong protection against tetanus and diphtheria and prevent maternal and neonatal tetanus.