Compliance with Hepatitis B screening guidelines at an Urban HIV Clinic with over 12,000 HIV positive clients in Kampala, Uganda; a mixed methods study

Abstract

Introduction/Background: Chronic infection with hepatitis B virus (HBV) is a global public health challenge and several international and national guidelines now recommend routine HBV screening in HIV positive individuals. However, little is known about compliance with HBV screening guidelines and the reasons that influence a clinician’s decision to screen for HBV are not clear.Objectives: This study aimed to understand the drivers of compliance with HBV screening guidelines among clinicians at Joint Clinical Research Centre (JCRC). Methods: A mixed methods study was conducted in August 2022 c in which quantitative and qualitative data were collected using concurrent triangulation method. The quantitative part involved a survey of medical records of all 763 HIV positive adults diagnosed between 1st January 2020 and 31st December 2021 at JCRC. The qualitative part involved 12 key informant interviews among clinicians at JCRC. The main outcome of the study was “compliance with HBV screening guidelines”. Quantitative data was analyzed using univariate analysis with STATA version 14.0. Bivariate and multivariate analysis were done using simple and multivariate logistic regression. Qualitative data was analyzed using inductive thematic analysis. Results: Clinician compliance with HBV screening guidelines was at 34.2%. The most perceived barriers were lack of reminders, work pressure and lack of support from policy makers. Other barriers included lack of awareness with HBV screening guidelines, lack of agreement with HBV screening guidelines, lack of motivation to adhere to the guidelines and patient financial constraints. Factors that facilitate clinician compliance include; being aware of HBV screening guidelines, having received HBV screening guideline training (AOR=2.86, 95% CI= 1.94-4.21, P<0.001), having reminders, agreement with HBV screening guidelines, availability of resources and having a patient with signs and symptoms of liver disease. Other facilitators included being a nurse (AOR=11.87, 95% CI =4.36-32.35, P<0.001), being female (AOR=2.80, 95% CI= 1.02-7.69, P=0.046), being 50 years or older (AOR=2.56, 95% CI= 1.03-6.39, P=0.043) and having spent 5 or less years providing HIV care (AOR=3.52, 95% CI=1.49-8.30, P=0.004). Conclusion: Findings from this study indicate that compliance with hepatitis B screening guidelines is low. This emphasizes the need for multifaceted implementation strategies that target the main barriers identified by this study.