Table 4. Interventions that have been used to tackle stigma in HBV, identified from a systematic literature review.

Category of intervention	Evidence from systematic literature review
Interventions targeting individuals with HBV infection	•   Provision of educational opportunities in health care settings, in the individual’s own language, can be valuable to inform patients of the importance of symptoms, treatment, follow-up, prevention and social stigma 32, 33, 43, 52;     •   Improving knowledge regarding the potential for silent complications, and understanding treatment could enhance willingness to access healthcare and reduce fatalism 32, 39;     •   Developing positive coping strategies may include seeking encouragement from spiritual leaders and open dialogue with family members 33, 43, 48, 55;     •   Lifestyle modifications can be helpful, such as reduced intake of alcohol and fatty foods 30, 33, 52;     •   Barriers to interventions should be considered (e.g. remote location, no internet access, language barriers) 62.
Interventions targeting HCWs	•   Education and training for HCWs should be improved, particularly for community doctors in rural settings 61; this includes training in diagnosis, prevention, treatment and monitoring 31, 33, 35, 37, 49, 53, and provision of appropriate pre- and post-test counselling 29, 33, 49;     •   HCWs can be deployed to design interventions to encourage participation in treatment programs and better self-care 55;     •   Education and communication programmes are needed to reduce stigma towards patients and colleagues with HBV infection 49– 51;     •   Championing a positive safety culture, such as strict infection control, may not only protect HCWs but can also improve the quality of patient care 50.
Interventions targeting communities and policy makers	•   Culturally appropriate education programs are required to improve knowledge on symptoms, modes of transmission and preventative measures, to correct misconceptions and decrease stigma; this could include use of internet, social media, radio, posters in public places (bars, markets, healthcare settings), and should involve schools and religious leaders 31– 36, 40, 41, 47– 49, 53, 55;     •   Specialised training on HBV for THs and ministers of faith could be a valuable approach 30;     •   Targeting individuals directly (e.g. with letters) might be of greater benefit than mass media campaigns 41;     •   Developing national campaigns to promote HBV screening and vaccination as positive strategies that can empower local communities in their own healthcare 40, 53;     •   Establishing a human connection can increase familiarity and reduce apprehension and negativity 42; for example, high profile public advocates have been successful in the ‘B Free Campaign’ 34, 40;     •   National strategic responses to HBV infection should specifically acknowledge and address the social implications of the infection 60, and should prioritise affordability of prevention and treatment 36.