Individual and Organizational Level Barriers to Post-exposure Prophylaxis Uptake for Hepatitis B Virus Among Midwives in Northern Ghana: A Qualitative Enquiry.

BACKGROUND

Hepatitis B virus (HBV) poses a significant occupational risk to healthcare workers (HCWs), particularly midwives in highly endemic settings such as Ghana, where frequent exposure to blood and bodily fluids during clinical practice increases their risk of occupational exposure and infection. Despite the availability of HBV vaccination and Post-Exposure Prophylaxis (PEP), uptake remains suboptimal due to multiple barriers. This study explores individual and organizational-level barriers to HBV PEP in northern Ghana.

METHOD: A qualitative exploratory study was conducted in the Kassena-Nankana West District of Ghana, involving 20 midwives recruited purposively from three healthcare facilities. Semi-structured interviews were conducted, and thematic analysis was used to identify key patterns in line with the socioecological model.

RESULTS

Two major overarching themes emerged across the individual and organizational socioecological levels. At the individual level, participants demonstrated inadequate knowledge of post-exposure prophylaxis (PEP) for HBV, including inadequate knowledge of the concept of PEP and HBV-specific protocols and guidelines. At the organizational level, health facility barriers included unstructured exposure reporting and PEP management pathways, absence of facility-level HBV-specific protocols and guidelines, and inadequate training on PEP for HBV were the factors identified as affecting PEP uptake.

CONCLUSION

Despite the availability of a national occupational health and safety policy recommending structured HBV PEP, protocol implementation at the facility level was weak, leaving midwives unprotected. The study underscores the urgent need for improved HBV education, structured exposure management pathways, and strengthened facility-level policies to enhance HBV PEP uptake. Addressing these gaps is crucial to reducing the risk of occupational HBV infection and ensuring midwives' safety in highly endemic settings.