Tested but unprotected? Uncovering missed opportunities in hepatitis B prevention among health professionals in Sierra Leone.

Abstract

**Introduction:** Hepatitis B virus (HBV) remains a major occupational hazard for healthcare workers (HCWs), particularly in low-resource settings like Sierra Leone, where systemic challenges hinder effective prevention efforts. Despite the availability of an effective vaccine since 1982 and widespread screening initiatives, HBV vaccination uptake among HCWs remains alarmingly low. This study investigates the disconnect between HBV screening and subsequent vaccination among HCWs in Sierra Leone, examining individual, institutional, and systemic factors.

**Methods:** we employed a mixed-methods cross-sectional design. A total of 432 HCWs were sampled across public, private, NGO, and faith-based hospitals using multi-stage techniques to assess screening uptake, vaccination coverage, and influencing factors. Additionally, 12 in-depth interviews were conducted with senior staff and health administrators. Quantitative data were analysed using SPSS, while the qualitative data were thematically analysed.

**Results:** = 317.27, p < 0.05).

**Conclusion:** the findings underscore critical missed opportunities in HBV prevention among HCWs in Sierra Leone. Despite moderate screening rates, vaccine coverage remains low, primarily due to institutional weaknesses such as inadequate follow-up systems, limited vaccine access, and weak policy enforcement - rather than individual neglect. These gaps place frontline health professionals at continued risk of HBV infection. Strengthening HBV prevention requires integrated screening-vaccination programs, mandatory occupational health policies, and sustainable vaccine supply systems. Targeted education, consistent advocacy, and inclusive strategies that engage all healthcare worker cadres are also vital. Such interventions are essential not only for protecting the healthcare workforce but also for reinforcing public health resilience in Sierra Leone.