Stakeholder perspectives on task shifting to prevent mother-to-child transmission of hepatitis B: A qualitative exploration of midwife- and nurse-led interventions in Vanuatu.

In Vanuatu, the management of hepatitis B is limited to hospital settings whilst antenatal care is decentralised to primary care settings, overseen by nurses and midwives. Scale up of interventions during pregnancy to prevent mother-to-child transmission (PMTCT) of hepatitis B in Vanuatu therefore requires task shifting of care for hepatitis B. This study aims to understand stakeholder perspectives on task shifting hepatitis B PMTCT interventions to midwives or nurses in primary care to increase access to services and decrease risk of mother-to-child transmission of hepatitis B in Vanuatu. Twelve semi-structured interviews were conducted with policy makers and key stakeholders involved in hepatitis B care at national and provincial levels. Interviews were recorded, transcribed and then translated into English. A deductive thematic analysis was undertaken. Key findings focused on acceptability, feasibility and sustainability. The importance of hepatitis B PMTCT was recognised and the need to improve access and coverage through task shifting was supported. Stakeholders felt nurses and midwives were highly trusted by the community and existing antenatal care roles were seen as supporting acceptability for hepatitis B task shifting. Supportive policies, guidelines and networks were required to enable nurses and midwives to provide hepatitis B PMTCT, some of which already exist. Stakeholders highlight the need to develop an enabling environment for sustainability, including appropriate resourcing, policies to formalise task shifting, pathways for communication and referrals, and increased client awareness and health education. There was support for the expansion of midwife- and nurse-led interventions for PMTCT of hepatitis B. However, there is a need for training, capacity strengthening and strengthening of supply chains to ensure continuity of availability of test kits and medication. Strengthening of these health system-level components will improve PMTCT efforts and broader maternal and child health.