Integrating Hepatitis B Elimination Into the HIV Program in Zambia

The study aims to develop and test a practical way of integrating hepatitis B (HBV) services into existing HIV care services in Zambia. It will first work with people living with HBV, healthcare workers, policymakers, and other stakeholders to understand current challenges and co-design an integrated HBV-HIV care model. The model will then be piloted in selected health facilities in Lusaka Province.

The study will assess whether the integrated model is acceptable, feasible, effective, and sustainable, with particular attention to HBV screening, linkage to care, treatment, health worker capacity, and service delivery. The findings will provide evidence to help the Ministry of Health determine how HBV services can be integrated into HIV programmes and potentially scaled up nationally.

• Integrated HBV/HIV Service Delivery Model (Other): This intervention encompasses a package which will include training, HBV screening campaigns and HBV vaccination campaigns.

Primary outcomes

• Implementation Outcome [Six-months post-intervention]: Pilot will be evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework

Other outcomes

• Acceptability [Six-months post-intervention]: Perception among stakeholders (e.g. clinic staff, patients) that the model is agreeable, satisfactory, worth using
• Completion of the integrated HBV-HIV service package (Feasibility) [Six-months post-intervention]: Percentage of enrolled participants who receive all services required by the study protocol, such as HIV testing or treatment review, hepatitis B surface antigen testing, clinical assessment, referral, and treatment or vaccination when indicated.
• Adoption [Six-months post-intervention]: Uptake and initial use of the innovation by the target provider
• Reach [Six-months post-intervention]: Primary reach outcome will be defined as the proportion of the target population that HBV screening.
• Fidelity [Six-months post-intervention]: Degree to which the intervention is delivered as intended by its protocol
• Cost [Six-months post-intervention]: Incremental cost of implementation with the integrated HBV model

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Healthcare Workers:

Inclusion Criteria:

* Age 18 years and above
* Work (provide services) at the 4 facilities across various cadres (both lay and professional)
* Have been working at facility for at least 6 months

Exclusion Criteria:

* None

Client participants:

Inclusion Criteria:

* Age 18 years and above
* Received at least one HBV-related service at the facility including but not limited to testing, enrollment for HBV care, and HBV antiviral medicines
* They consider the facility their medical home
* If HBV-positive are willing to stay in care at the same facility

Exclusion Criteria:

\- The person was NOT enrolled in the Hep-Mec study and NOT enrolled in the Liver Fibrosis study irrespective of screening status