Work package 3: Health systems and implementation research

WP3 is led by Blessings Kapumba and Julie Balen

While clinical trials have demonstrated the efficacy of tenofovir in preventing HBV MTCT in women with high viral loads, there is a critical knowledge gap regarding how this intervention can be operationalised at scale in resource-limited settings. These settings are characterised by fragile health systems, limited laboratory capacity, workforce constraints, and complex socio-cultural dynamics that influence health service uptake.

 Malawi and The Gambia exemplify such contexts, where routine viral load testing is not widely available, HepB birth dose vaccination coverage is suboptimal, and cultural perceptions about HBV and pregnancy vary widely. 

WP3 will address these gaps by investigating health system factors and implementation processes that influence the uptake, fidelity, and sustainability of the screen-and-treat-all strategy. Employing the updated CFIR, this work package systematically examines multi-level determinants including organisational readiness, health worker capacity and attitudes, policy environment, community and patient acceptability, and communication networks that affect successful integration of HBV prophylaxis into routine antenatal care

Work package 3 activities aim to conduct social science research to evaluate the perceptions of pregnant women, stakeholders, healthcare workers and policy makers.