Healthcare Workers' Experiences With Hepatitis B Virus Post‐Exposure Prophylaxis Management at a Military Hospital in Ghana: A Qualitative Study

ABSTRACT

Background

Hepatitis B virus (HBV) infection poses a significant occupational risk to healthcare workers (HCWs), particularly in high‐endemic settings like Ghana. Despite the availability of post‐exposure prophylaxis (PEP), adherence remains suboptimal due to systemic and individual‐level barriers.

Aim

This study explored the experiences of HCWs in managing HBV PEP following occupational exposures.

Methods

An exploratory qualitative design was employed at a Military Hospital in Accra. Data were collected through 5 focus group discussions and 13 in‐depth interviews with a diverse sample of HCWs, including doctors, nurses, EMTs, and laboratory staff. Participants were purposively selected based on their exposure risk and/or involvement in PEP coordination. Thematic analysis was conducted using Braun and Clarke's framework.

Results

Four themes emerged. (1) Resource availability was a critical factor in PEP adherence. Inconsistent access to HBV test kits, protocols, and the high cost of vaccines and HBIG hindered response. (2) Psychological factors, including fear of infection and stigma, shaped reporting and follow‐up behaviors. Peer and supervisor support improved adherence, while past negative experiences with HIV PEP deterred reporting. (3) Hospital policies and guidelines were inadequately implemented, often favoring HIV over HBV. Risk assessments were inconsistently conducted, and HBV was rarely included in training sessions. (4) Challenges with adherence, such as forgetfulness and poor knowledge of HBV PEP protocols, undermined completion of the vaccine series and appropriate post‐vaccination testing.

Conclusion

HCWs' experiences with HBV PEP management reveal a complex interplay of structural, institutional, and psychological factors. Strengthening HBV‐specific training, subsidizing vaccines, improving access to diagnostic tools, and reducing stigma are critical for enhancing PEP adherence. Findings inform policy and intervention strategies to protect HCWs in HBV‐endemic settings.

1. Introduction

Hepatitis B virus (HBV) infection remains a major global public health challenge, with significant morbidity and mortality, particularly in low‐ and middle‐income countries [1]. The World Health Organization (WHO) estimates that ~254 million people are currently living with chronic HBV infection [2], with sub‐Saharan Africa accounting for a large proportion of this burden [3]. In Ghana, the prevalence of HBV is estimated to range between 12.3% and 14% [4, 5], placing the country in the high endemicity category. Healthcare workers (HCWs) in high‐endemic settings are at increased occupational risk of HBV infection due to their frequent exposure to blood and other potentially infectious materials during the course of their duties [6]. Studies conducted in Ghana have demonstrated that HCWs are routinely exposed to blood and body fluids through percutaneous and mucocutaneous routes [7, 8, 9]. These occupational exposures are associated with a documented high risk of serological evidence of HBV exposure, thus 8.2% [10], as well as a high prevalence of 5.9% HBV infection among this population [11].

Despite the constant occupational exposure to hepatitis HBV among HCWs, the uptake of pre‐exposure prophylaxis, specifically the administration of the HBV vaccine according to the recommended 0‐, 1‐, and 6‐month schedules, remains suboptimal within the HCW population in Ghana [12, 13] and many other endemic countries [14, 15]. Consequently, post‐exposure prophylaxis (PEP) offers a critical safety net for HCWs who lack adequate protection against HBV due to incomplete or absent pre‐exposure immunoprophylaxis [16, 17].

PEP is a critical component of occupational health and safety for HCWs exposed to HBV, especially following needle‐stick injuries, cuts, or mucosal contact with infected fluids [18, 19]. HBV PEP typically includes administration of HBV Immunoglobulin (HBIG) and/or initiation or completion of the HBV vaccine series, depending on the exposed worker's vaccination and serological status [20, 21]. Timely and appropriate management of HBV exposure incidents can significantly reduce the risk of seroconversion and subsequent chronic infection [19]. However, in many health facilities across low‐income settings, the implementation and adherence to HBV PEP protocols face numerous challenges, ranging from inadequate awareness and training among staff [16] to a lack of clear reporting systems and inconsistent availability of PEP commodities [22].

The Military health facility in Ghana, which is a major tertiary and referral health facility, serves both civilian and military populations and employs a diverse cadre of health professionals. The hospital's scale and scope of operations place its HCWs at substantial risk of occupational exposure to HBV. Despite existing policies on infection prevention and control, anecdotal evidence and preliminary reports suggest that knowledge, attitudes, and practices related to HBV PEP among staff vary widely. Similarly, this is also evident in studies related to HIV PEP knowledge, attitude, and practices [23, 24]. Understanding the lived experiences of HCWs in managing HBV exposure, including their awareness of protocols, motivating and demotivating factors of PEP use, and accessibility of PEP services, is critical for informing interventions to strengthen occupational health systems and ensure better protection for frontline workers.

Moreover, while studies on HBV epidemiology and vaccination coverage among HCWs in Ghana exist [12, 13], there remains a paucity of research focusing specifically on the qualitative aspects of their experiences with PEP management. Workers' perspectives can provide rich insights into systemic gaps, cultural and institutional attitudes toward occupational health, and the extent to which staff feel supported following exposure incidents.

This study, therefore, seeks to explore the experiences of HCWs in managing HBV PEP following occupational exposure.

2. Methodology

2.1. Study Design

This study adopted an exploratory qualitative design, utilizing a narrative research approach to generate in‐depth insights into HCWs' experiences with HBV PEP management. Focus group discussions (FGDs) and in‐depth interviews (IDIs) were used to enable a rich understanding of the subjective experiences, perceptions, and contextual factors influencing PEP practices among HCWs. The study design, data collection, analysis, and reporting were guided by the Standard for Reporting Qualitative Research to ensure transparency, rigor, and comprehensive reporting of the qualitative research process and findings.

2.2. Study Setting

The research was conducted at a Military Hospital in Ghana. The hospital is the foremost military healthcare facility in the country. It serves both civilian and military populations and functions as a tertiary referral center. The facility has a bed capacity of ~500 and employs over 3500 HCWs, comprising both civilian and military personnel. It provides round‐the‐clock inpatient and outpatient services across various medical specialities and serves as a teaching hospital for multiple institutions, including medical schools, nursing, and allied health training institutions.

2.3. Study Population

The study population included a wide range of HCWs of the Military Hospital who provide direct clinical care and are therefore at increased risk of HBV exposure. These comprised doctors, nurses, midwives, nurse assistants, emergency medical technicians (EMTs), orderlies, dental assistants, and laboratory technicians. Participants also included personnel designated as PEP focal persons from key clinical units such as the surgical, medical and gynecological emergency units, intensive care unit, maternity ward, theater, Debrah Ward (Infectious Diseases Ward), and many others. Individuals who had worked in the facility for < 1 year, were not in direct patient care activities or worked as occupational health and safety focal persons for < 1 year were excluded from the study.

2.4. Sampling and Sample Size

A purposive sampling technique was employed to recruit participants. Focus groups comprised a maximum of ten participants in each group, representing diverse professional categories, per guidelines by Guest et al. [25]. A total of five FGDs were conducted. In addition, individual IDIs were held with key informants, including staff, PEP focal persons, and shift or ward in‐charges from various clinical departments. Data saturation was attained after interviewing the 13th participant, and the researchers observed and agreed that subsequent interviews revealed no new emerging information, themes, or insights.

2.5. Ethical Considerations

Ethical approval was obtained from the Institutional Review Board of the Military Hospital. The study commenced upon receipt of ethical clearance (Approval Number: 37MH‐IRB/MSHP/IPN/867/2024). Administrative permissions were granted by the Commander of the hospital and ward/unit heads. Written informed consent was obtained from all participants after reviewing the study information sheet. Participants were assured of confidentiality, the voluntary nature of participation, and their right to withdraw at any point without penalty. Although the nature of the study required participants to reflect on potentially distressing experiences, no emotional distress was reported during the data collection process.

2.6. Data Collection Tools and Procedure

Data were collected using a semi‐structured interview guide for the IDIs and the FGD guide for the FGDs. The instrument was developed based on PEP for HBV management pathway recommendations outlined by Senoo‐Dogbey et al. [21] and other previous studies [19, 26, 27]. The guide was designed to be flexible, allowing for probing and dynamic dialog during discussions. The instruments were validated via expert review and pretesting. Modifications were made accordingly. Five focus group FGDs were conducted with 4–10 participants each, drawn from high‐risk units. Participants included a diverse mix of HCWs such as doctors, nurses, midwives, EMTs, and laboratory staff, as well as coordinators. FGDs lasted between 60 and 90 min. Discussions were conducted in English, audio‐recorded with consent, and transcribed verbatim. The interactive group setting facilitated the exploration of shared experiences, institutional influences, and barriers to PEP use. This method provided rich contextual data on PEP management from a collective perspective.

The IDIs were conducted with 13 key informants, including post‐exposure focal persons, ward in‐charges, and shift supervisors, as well as staff across high‐risk units. Participants were purposively selected based on their roles in patient care, managing, or coordinating PEP protocols. A semi‐structured interview guide was used to explore personal experiences, decision‐making processes, and institutional practices. Interviews lasted ~30 min and were conducted in English at times convenient for participants. All sessions were audio‐recorded with consent and transcribed verbatim. The IDIs allowed for detailed, individual insights into PEP management practices and systemic challenges.

2.7. Data Analysis

Data analysis was conducted concurrently with data collection to ensure a responsive and iterative process. Audio recordings were securely stored, transcribed verbatim, and anonymized using pseudonyms. Thematic analysis, as outlined by Braun and Clarke [28], guided the analytical process. The six‐phase framework familiarization, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the final report, was employed. Transcripts were thoroughly read and re‐read by all investigators to achieve immersion in the data. Data were exported to QSR NVivo‐14 for the systematic development of codes. Initial codes were assigned to salient features relevant to the study objectives, particularly factors influencing HCWs' PEP management practices. Coding reliability was ensured through debriefing and agreement among researchers. Coded data were then organized into overarching themes and subthemes. The coherence and representativeness of each theme were reviewed in relation to the data set. The themes were clearly defined and supported by direct quotations from participants to enhance credibility and authenticity.

2.8. Rigor

Trustworthiness, a key element in qualitative research, was ensured through the framework proposed by Guba and Lincoln [29]. Credibility was established by incorporating verbatim quotes to reflect participants' experiences and through member checking, where participants verified the accuracy of transcribed data and emerging themes. Confirmability was supported through reflexivity and bracketing to minimize researcher bias and ensure neutrality. Researchers ensured that participants' responses were not influenced by any potential personal biases by documenting personal assumptions and decisions that could influence data interpretation. Transferability was promoted by providing a detailed account of the study context and methodology to allow for replication in similar settings.

3. Results

3.1. Sociodemographic Characteristics of Study Participants

A total of 58 HCWs participated in the study, comprising 15 males and 43 females. The participants represented a broad range of professional categories, including doctors (n = 5), nurses (n = 16), midwives (n = 6), nurse assistants (n = 8), EMTs (n = 5), orderlies (n = 10), laboratory technicians (n = 4), and dental assistants (n = 4). In terms of educational background, 10 participants held master's degrees, 13 had bachelor's degrees, 10 had diplomas, and 25 held certificates. Regarding years of working experience, the majority of participants (n = 33) had between 1 and 10 years of professional experience. Sixteen participants had worked for 10–20 years, while nine had between 20 and 30 years of experience (Table 1).

Table 1.

Demographic characteristics of participants.

Demographic characteristic	Frequency	Percent (%)
Sex
Male	15	25.86
Female	43	74.14
Professional category
Doctors	5	8.6
Nurses	16	27.6
Midwives	6	10.4
Nurse assistants	8	13.8
Emergency medical technicians	5	8.6
Orderlies	10	17.2
Laboratory technicians	4	6.9
Dental assistants	4	6.9
Educational background
Master's degree	10	17.24
Bachelor's degree	13	22.41
Diploma	10	17.24
Certificate	25	43.10
Years of working experience
1–10 years	33	56.90
10–20 years	16	27.59
20–30 years	9	15.52

3.2. Themes and Subthemes

As outlined in Figure 1, the study found four main themes shaping HBV PEP management at the Military Hospital: resource availability (protocols, rapid test kits, and vaccines enabling timely response), psychological factors (fear, stigma, colleague support, and negative impact of prior HIV PEP experience), hospital policies and guidelines (routine assessments and follow‐up by focal persons), and challenges (vaccine issues and limited PEP knowledge). These highlight how both systemic factors and individual responses influence post‐exposure care (Figure 1).

Figure 1.

Summary of themes and subthemes.

3.2.1. Theme 1: Resources for Post‐Exposure Management

Resource availability was central to effective PEP implementation. Key enablers included the PEP protocol, which offered clear guidance and built confidence, HBV rapid test kits for timely risk assessment, and readily accessible HBV vaccines to avoid delays. Their absence was linked to hesitancy, anxiety, and poor adherence.

3.2.1.1. Post‐Exposure Management Protocol

It was established that the facility has a protocol for PEP management, and this protocol contains all the necessary details and steps required for staff to follow after exposure to contaminated blood and body fluids. However, not all staff are familiar with the protocol. This is expressed in the following quotes.

We have no protocol in my unit, which affected my response to a needle prick. I squeezed the site before washing, but later learned this was wrong. Having a protocol would have helped.

GD5; P1

Another participant who is a focal person for post‐exposure management shared this:

We used to have the protocol posters pasted on the walls in the ward, which tells you exactly what to do if you have exposure, but as the wards were painted recently, the protocols were taken off or removed paint, and they have not been replaced.

GD3; P4

Some of the participants are much more familiar with the protocol for immediate management of needle stick injuries. This is what a participant had to share:

Apart from the needlestick protocol, we have no guidance for blood or body fluid splashes; we just wash the site with chlorine or Savlon, depending on the area.

GD2; P5

3.2.1.2. Test Kits for HBV

HBV test kits were also identified as resources needed for the assessment of staff who were exposed. During the discussions, participants mentioned that on their various wards, rapid diagnostic test kits for HIV were always readily available, unlike those for HBV. The nonavailability of test kits was a major hindrance to their adherence to the post‐exposure management of HBV. Participants shared their stories.

HBV, the test kit doesn't come readily like HIV. I know we have an HIV test kit here, but for hepatitis, no. Even when the exposure occurs, the staff involved wants to test the patient for HIV and not HBV. But it's also a very easy infection to get. Yeah, very easy.

IDI; 7

You know, these HBV test kits are not readily available. And it's my reason for saying post‐exposure management for HBV is not friendly to us. The test kits are kind of localized in the public health department. I had a needle prick during the COVID‐19 pandemic, and the HIV test kit was available. Fortunately, when we tested, the person was negative, and that ended it. I did not go further to test for HBV. So, in our department, HBV kits should be available, just like the HIV test kits.

GD1; P2

3.2.1.3. HBV Vaccine and Immunoglobulin (HBIG)

Adherence to the reporting protocol ensured timely access to HBV vaccines and HBIG after exposure. However, participants noted that the cost of post‐exposure vaccination, often paid out‐of‐pocket, was a significant barrier despite vaccine availability.

Yes, when you go to the public health department, they will test you before they give you the vaccine. And then you pay. It's not expensive, I think, about 35 or 45 cedis. The immunoglobulin is expensive; you can spend 500 or more.

GD2; P4

Vaccine access was quick when guided by a supervisor, but cost remained a burden, especially when unplanned; providing it for free could make access easier and encourage reporting.

GD3; P3; IDI; P10

3.2.2. Theme 2: Psychological Factors

Psychological responses to HBV exposure both supported and hindered PEP adherence. Fear of infection encouraged prompt reporting, while shame and stigma caused delays. Support from colleagues and prior HIV PEP experience improved confidence and engagement.

3.2.2.1. Fear of Infection

While some participants indicated that they tested and reported mainly because they were afraid, other participants also adhered to the schedule for post‐exposure vaccination because they were afraid of getting infected with HBV early in their careers. These are some stories they shared:

First of all, I adhered because I was afraid. The most motivating factor to adhere to is that I have been exposed, and if I don't take the PEP, I put myself at risk of being infected.

GD3; P3

I didn't take the prophylaxis. I only screened the patient because of fear, and once the patient was negative, that was it.

GD5; P4

I had my needle stick injury from a Hep B‐positive patient, so I went to check for myself, and then later on, I went to take the HEP B vaccination. I become afraid when I remember.

GD2; P6

But the reason why they came back later to report is the fear of being infected after they might have discussed it with their peers.

IDI 3

3.2.2.2. Stigmatization

It was observed that an exposed staff member is likely to face stigma from colleagues in the same ward and, in some cases, while going through the post‐exposure assessment.

I do not even report in the first place because of the toxic work environment. In my previous experience with exposure, I was blamed for using my needle stick injury as an excuse to get an excuse of duty.

GD5; P6

No, ooh, this room, nooooh, it was between me and my in‐charge. We didn't report it. Even though I was worried.

GD2; P5

I had an experience with public health officials when I reported my needle stick injury to them. Before he conducted the rapid diagnostic test for me, he said if the test turns out to be positive, then it is an already existing infection.

GD1; P1

3.2.2.3. Support From Colleagues and Supervisors

The support received by staff who experienced exposure to HBV, from their colleagues and supervisors, was also a motivating factor for adherence. For other participants, it made no difference in their decision‐making. This is what some participants had to share:

When I had my needle prick, my Nursing Officer‐In‐Charge called me almost every day to find out if I had done all the labs; she was even willing to support me financially if there was a challenge. She encouraged me on the phone and ensured that I was given an excuse for duty for a few days. So, as for my ward, support is top‐notch.

GD5; P9

In my ward, one of our colleagues also had a needle stick injury. When we heard about it, we called him regularly to check up on him, and he mentioned that it helped him psychologically because initially, he was afraid and had so many “what ifs” in mind.

GD3; P4

Even though support was available to the participants, some participants verbalized that it was not the primary motivation for their adherence to post‐exposure management.

The first motivation for me is my health, then the top‐up will be the follow‐up calls. Yes, that becomes some sort of motivation, but the first motivation is so that you don't stand the chance of getting the infection.

GD3; P5

3.2.2.4. Previous Experiences With HIV PEP Medications

One other psychological challenge shared by participants as influencing their adherence to post‐exposure management for HBV was their past experiences with post‐exposure medication for HIV.

I felt very weird the first day I started taking the PEP for HIV exposure. Especially in the evening, I felt like I was dying. So, this feeling does not even encourage me to report any other exposure I have had.

GD5; P3

The HIV PEP medication is very big, and the sight of it even scared me. Unfortunately, my second needle stick injury, I did not even report, and even though the patient was HBV positive, I didn't want to have any negative experience with any PEP treatment.

GD5; P1

3.2.3. Theme 3: Hospital Policies and Guidelines

Participants identified gaps in HBV post‐exposure management, noting weaknesses in assessment, follow‐up, and training. They highlighted that institutional focus and resource constraints often favored HIV, leaving HBV exposures under‐prioritized.

3.2.3.1. Post‐Exposure Assessment

Post‐exposure risk assessment and testing to determine their eligibility to take the prophylaxis were not adequately done. In cases where the source of the exposure is unknown, only the staff were assessed. Participants indicated that, in most cases, patients were not tested, while in a few cases, staff status was assessed after exposure, depending on the ward you are operating.

HBV was not tested because the test kit wasn't available on the ward. We only tested for HIV, and that's all. Once the HIV was negative, that ended it. This is why I said HBV and post‐exposure management are not well known to me.

GD2; P3

As a focal person for over 8 years, I've seen the post‐exposure protocol mainly favour HIV. I often skip HBV screening if the patient's status is unknown, as it requires payment, and many patients can't afford labs or medication.

IDI; 6

3.2.3.2. Follow‐up by the PEP Focal Persons

The hospital has a policy in place where each ward has a focal person who counsels, tests staff and patients when there is an exposure to all blood‐borne pathogens and then refers the staff to the public health department for PEP. These focal persons also guide staff on the necessary steps to take, where the post‐exposure protocol is not available on the wards in the event of an exposure.

Yes, so with every ward, we always have a representative handling post‐exposure. So, immediately there is an exposure, we contact them, and then the necessary steps will be taken. There will be follow‐ups to ensure that the exposed staff adhere to the management protocol from reporting to PEP uptake.

GD3; P2

The PEP focal person at the public health unit followed us back to the ward after I reported my exposure to them. They explained everything to the patient, she understood, and they did the test for both of us.

GD1; P1

3.2.3.3. Training and Continuous Education Programs on HBV Exposures

Participants mentioned that the hospital organizes training and education programs on exposure and post‐exposure management; however, this is always centered around HIV/AIDS because it is usually sponsored. The individual wards also barely factor in post‐exposure management of HBV in their training and orientations.

The hospital doesn't organise training on HBV and HBV post‐exposure management frequently. We go for training for PEP, and basically, it is mostly based on HIV, so the emphasis is on HIV and not hepatitis B. I am yet to see a training that capitalises on HBV exposure prophylaxis.

GD3; P5

As a focal person at least every quarter, I attend training on HIV and PEP for exposures, including HIV data reviews, but I have never attended anything related to hepatitis B.

IDI 5

In fact, as a ward in charge, I usually orient the new staff, students and rotation nurses to the ward, but we have never considered post‐exposure management for HBV as a topic to discuss a seek knowledge on.

IDI 2

3.2.4. Theme 4: Challenges With Adherence to PEP Management

A key theme that emerged from the data was the challenges surrounding HBV vaccination among HCWs. Two interrelated subthemes were identified: forgetfulness and inadequate knowledge of HBV vaccination and PEP management regimen. These challenges affected participants' adherence to the HBV vaccination schedule and their understanding of its purpose and post‐vaccination follow‐up.

3.2.4.1. Forgetfulness

Participants described difficulties in completing the HBV vaccine series due to the long intervals between doses. Forgetfulness was a commonly cited reason for missed or delayed doses, often resulting in disruptions in the vaccination schedule. While some eventually returned to complete their vaccinations, others did not. One participant shared:

After taking my first dose of the vaccine, I was given a schedule to follow monthly, but I forgot I had to go for a vaccination. I went back 3 months later to enquire, and they continued for me.

GD3; P4

3.2.4.2. Knowledge of HBV Vaccination and HBV PEP Management

The knowledge gap in HBV vaccination was also identified as a challenge. Participants mentioned that their knowledge of HBV is very shallow compared to that of HIV and even COVID‐19. This had impacted their acceptance and adherence to HBV PEP management. These experiences were shared.

The knowledge of HBV is not good at all, unlike that of HIV, COVID‐19, etc. HBV is not that common. And to me, the vaccine is expensive, since it's not free like that of COVID and HIV PEP. So I have still not taken it.

GD5; P6

Honestly, I had no idea they had to be managed differently. Maybe I got it wrong because of the tenofovir in the antiretrovirals. I never knew there was PEP for HBV exposures.

GD3; P5

I was told I had to take 3 doses of the vaccine, so after completing it, I didn't go back there. Maybe it was because I didn't know I had to do the test again to check if the vaccine was effective or not.

GD2; P1

4. Discussion

This study explored HCWs' experiences with HBV PEP management at a tertiary hospital in Ghana. The findings highlight systemic, institutional, and individual‐level factors that shape PEP management. Four key themes emerged: resources for PEP management, psychological factors, hospital policies and guidelines, and challenges with vaccines and overall awareness of HBV.

4.1. Resources for Post‐Exposure Management

Availability of resources emerged as a foundational determinant of HBV PEP management. Participants emphasized that protocols, test kits, and vaccines were critical for timely and effective responses following occupational exposure. However, access varied across wards. Although a protocol existed, some staff lacked familiarity with its content, and physical copies were often unavailable, particularly after renovations. This aligns with findings from Senoo‐Dogbey and colleagues, who reported inconsistent dissemination of PEP guidelines within the Ghanaian health facilities [30].

Contrary to the recommendations by the CDC for rapid access to HBV testing and logistics for HBV exposure management [31], the absence of HBV rapid diagnostic test kits reported in this study posed a major challenge, leading to over‐reliance on HIV testing and the neglect of HBV risk assessment. Similar gaps have been identified in other low‐resource settings, where vertical programs have created service imbalances favoring HIV [22]. The centralization of HBV testing in the public health department often delayed timely intervention and discouraged reporting for HBV PEP management if HIV results were negative.

While HBV vaccines and HBIG were reportedly accessible once exposures were formally reported, the associated costs were a major barrier. In contrast to free HIV PEP, participants were expected to pay out‐of‐pocket for HBV interventions; this is a deterrent to effective PEP management that has been echoed in studies done in other endemic settings [32]. Participants called for HBV vaccines to be subsidized as part of routine occupational healthcare, consistent with international occupational safety guidelines.

4.2. Psychological Factors

Psychological reactions significantly influenced HBV PEP management. Fear of infection served as a key motivator for some HCWs, prompting them to test and follow protocols immediately after exposure. This behavior is consistent with research in other settings showing that fear, anxiety, depression, and feelings of guilt are associated greatly with occupational exposures and drive initial PEP‐seeking behavior [33, 34].

Several participants reported reluctance to report exposures due to fear of being stigmatized and perceived as negligent and lazy. This mirrors findings from Kenya, where stigma was linked to underreporting and protocol nonadherence [35, 36]. Worryingly, some participants even experienced shaming comments from public health officials, highlighting a need for trauma‐informed approaches in occupational health services.

Peer and supervisor support played a buffering role, enhancing emotional well‐being and encouraging protocol adherence. These findings reflect the importance of social support systems in promoting occupational safety and reducing workplace stress [37]. However, while supportive environments were helpful, participants still saw personal health as the primary motivation for PEP uptake.

Previous negative experiences with HIV PEP medications, including severe side effects and pill burden, discouraged future reporting even when exposed to HBV‐positive patients [38]. These experiences of anticipatory avoidance point to the need for better education and a clearer distinction between HIV and HBV PEP management pathways.

4.3. Hospital Policies and Guidelines

Participants identified several institutional shortcomings in PEP policy implementation. Although risk assessment was a mandated step following exposure, in practice, it was inconsistently applied, often excluding HBV testing due to cost and logistical barriers. Staff tended to rely on HIV testing as a proxy for risk, ignoring the potential for HBV transmission [22]. This prioritization of HIV reflects broader systemic imbalances tied to external funding and programmatic focus.

Focal persons were designated to coordinate PEP processes within wards, and their presence was generally seen as beneficial. However, their effectiveness was limited by the lack of HBV‐specific tools, such as rapid test kits. This weakened their ability to implement equitable, multipathogen responses. Gilson highlights similar constraints in health systems where frontline roles are unsupported by institutional capacity [39].

A critical gap in this study was the lack of HBV‐focused training and continuous education. Participants reported that staff development sessions centered almost exclusively on HIV, with HBV rarely mentioned during orientations or in‐service training. Similar findings were in Uganda, an African setting where HBV remains underemphasized despite its significant occupational risks [40]. Integrating HBV into standard PEP curricula and institutional discourse is necessary to close this knowledge and implementation gap.

4.4. Issues With HBV Vaccine Knowledge and PEP Management

Finally, individual‐level barriers such as forgetfulness and limited knowledge of HBV PEP regimens significantly affected vaccine adherence. The multidose schedule with months between doses was cited as a challenge, and without active reminders, participants often failed to complete the full series. This is consistent with broader global evidence showing that long intervals between vaccine doses lead to poor completion unless reinforced with structured follow‐up systems [32].

A more concerning finding was the general lack of understanding about HBV immunity. Participants were often unaware that vaccine‐induced immunity should be confirmed through post‐vaccination serology testing. Others incorrectly believed that HIV PEP regimens covered HBV exposure or assumed full protection after a single dose. These misconceptions are consistent with studies from Uganda showing widespread misinformation and inadequate education among HCWs [40]. Compounding this was a lack of institutional messaging around HBV PEP. Compared to HIV and COVID‐19, which benefited from widespread public education campaigns, HBV appeared less visible both in clinical and public health communication. The result was an asymmetry in awareness and engagement that weakened adherence to the HBV PEP regimen.

5. Strengths and Limitations

This study provides valuable insights into HBV PEP management among HCWs in a resource‐limited military hospital. The use of FGDs and IDIs strengthened the study by enabling triangulation and a deeper understanding of shared and divergent experiences. Diverse participants, including clinical staff and PEP focal persons, allowed for a comprehensive exploration of challenges. The study's limitations include its single‐site focus and potential biases in self‐reported data. The absence of policy‐level stakeholders also limits broader institutional insights. Despite these, the study offers important evidence for improving HBV PEP adherence and occupational safety in similar settings.

6. Conclusion

This study explored HCWs' experiences with HBV PEP at a military hospital in Ghana. Key barriers to adherence included limited access to HBV test kits, high vaccine costs, inadequate training, and knowledge gaps. Psychological factors such as fear, stigma, and prior negative experiences with HIV PEP also shaped reporting behaviors. Hospital policies often favored HIV, leaving HBV underprioritized. Forgetfulness and misconceptions about vaccination further reduced adherence. Improved training, subsidized vaccines, decentralized diagnostics, and a supportive workplace culture are essential. Strengthening these areas will enhance HBV PEP uptake and better protect HCWs.

Author Contributions

Narh Berlinda Lasidji Narh: conceptualization, investigation, writing – original draft, methodology, writing – review and editing, project administration, data curation, resources. Vivian Efua Senoo‐Dogbey: conceptualization, methodology, validation, supervision, writing – review and editing, writing – original draft, project administration. All authors have read and approved the final version of the manuscript. Corresponding author Senoo‐Dogbey Vivian Efua had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

The authors received no specific funding for this work.

Disclosure

The lead author Senoo‐Dogbey Vivian Efua affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Ethics Statement

The study was approved by the Institutional Review Board of 37 Military Hospital (IRB Number: 37MH‐IRB/MSHP/IPN/867/2024).

Consent

Informed consent was sought and documented from participants.

Conflicts of Interest

The authors declare no conflicts of interest.

Lasidji Narh B., and Senoo‐Dogbey V. E., “Healthcare Workers' Experiences With Hepatitis B Virus Post‐Exposure Prophylaxis Management at a Military Hospital in Ghana: A Qualitative Study,” Health Science Reports 9 (2026): e71867, 10.1002/hsr2.71867.

Data Availability Statement

Data are available from the corresponding author upon reasonable request.