RT Journal Article
SR Electronic
T1 Implementation Approaches for Introducing and Overcoming Barriers to Hepatitis B Birth-Dose Vaccine in sub-Saharan Africa
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2100277
DO 10.9745/GHSP-D-21-00277
VO 10
IS 1
A1 Alix Boisson
A1 Varun Goel
A1 Marcel Yotebieng
A1 Jonathan B. Parr
A1 Bruce Fried
A1 Peyton Thompson
YR 2022
UL http://www.ghspjournal.org/content/10/1/e2100277.abstract
AB Key FindingsA review of 39 articles outlining the experience of introducing the hepatitis B birth-dose (HepB-BD) vaccine in low- and middle-income countries in sub-Saharan Africa identifies the potential barriers to the vaccine's uptake.Empirical examples of policy makers targeting the mother's role to increase uptake of HepB-BD vaccine at the community level are strikingly scarce, and efforts to leverage community-level resources and reach remote areas have been limited.Key ImplicationsWe provide solutions that must be adapted to the local context to overcome the barriers to HepB-BD uptake identified across policy, facility, and community levels.Synergy must exist between policy, facility, and community level implementation for sub-Saharan African countries to effectively implement a universal HepB-BD vaccine immunization policy.For sub-Saharan African country policy makers to effectively implement a universal HepB-BD immunization policy, synergy must exist between the policy-, facility-, and community-level efforts.In sub-Saharan Africa (SSA), chronic viral hepatitis B (HBV) affects more than 60 million people. Mother-to-child transmission is a major contributor to the ongoing HBV epidemic and yet only 11 of 54 (20.3%) SSA countries have introduced the birth dose of HBV vaccine (HepB-BD) into their regular immunization schedule. As more African countries adopt HepB-BD, implementation approaches must be targeted to ensure effective and timely HepB-BD delivery, especially in rural and under-resourced settings. We conducted a systematic literature review of published literature using PubMed. We included 39 articles published from January 2010 to August 2020, as well as gray literature, case studies, and research performed in SSA. We describe barriers to the uptake of HepB-BD in SSA at the policy, facility, and community levels and propose solutions that are relevant to stakeholders wishing to introduce HepB-BD. We highlight the importance and challenge of reaching infants who are born outside of health care facilities (i.e., home deliveries) with HepB-BD in partnership with community health workers. We also discuss the critical role of maternal education and community engagement in future HepB-BD scale-up efforts in SSA.