{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T04:36:26Z","timestamp":1769142986709,"version":"3.49.0"},"reference-count":38,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,8]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Introduction<\/jats:title>\n Viral hepatitis B (HBV) and C (HCV) infections remain major public health threats in Ghana, with prevalence rates significantly higher in prison populations than in the general population. Despite this, incarcerated individuals are frequently excluded from national testing and treatment programmes. Overcrowding, poor sanitation and limited access to healthcare create a high transmission risk. There is an urgent need for targeted, evidence-based interventions to address this health inequity and support Ghana\u2019s progress towards viral hepatitis elimination.<\/jats:p>\n This protocol describes a study designed to evaluate the effectiveness of a multicomponent targeted educational intervention in increasing knowledge, intention to test, testing uptake and treatment initiation for HBV and HCV among adult prison inmates in the Greater Accra and Eastern Regions of Ghana.<\/jats:p>\n <\/jats:sec>\n \n Methods and analysis<\/jats:title>\n A cluster randomised controlled trial (RCT) with a 1:1 parallel design will be conducted in eight prisons stratified by gender (six male, two female) with 208 inmates per arm. The intervention group will receive the Prison Education for Prevention of Hepatitis Intervention, comprising an education programme (posters, infographics, film screenings, peer-led discussions and structured health education) alongside HBV and HCV testing, treatment and care linkage. The control group will receive standard health education and basic printed materials. Testing intentions, uptake, prevalence and treatment outcomes will be measured. Cost-effectiveness analysis will inform sustainability and scale-up. The primary endpoint is uptake of hepatitis B and C testing. Secondary outcomes include changes in hepatitis knowledge and testing intentions, prevalence of hepatitis B and C, treatment uptake among diagnosed inmates, linkage to hepatitis care services and cost-effectiveness of the intervention.<\/jats:p>\n Data will be analysed, accounting for prison clustering, using mixed-effects models and regression methods. Outcomes include testing uptake, knowledge, intentions, prevalence, treatment initiation and sustained virologic response, adjusted for key covariates. Baseline characteristics and intervention reach will be summarised descriptively. Analyses will follow intention-to-treat and Consolidated Standards of Reporting Trials guidelines. Cost-effectiveness will estimate Incremental Cost Effectiveness Ratio (ICERs) per inmate tested, infection detected and treatment initiated.<\/jats:p>\n <\/jats:sec>\n \n Ethics and dissemination<\/jats:title>\n The RCT was approved by the College of Health Sciences ethics and protocol review committee (no. CHS-E\/M.1-P 4.7\/2025\u20132026). Results will be presented at relevant national and international meetings and conferences and will be published in international peer-reviewed journals. Furthermore, we plan to communicate the results to relevant stakeholders in the Ghanaian Prisons and Healthcare systems.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n PACTR202512558588684.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114815","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T14:10:36Z","timestamp":1769091036000},"page":"e114815","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["PEP-Hep: A cluster randomised controlled trial of a prison education programme to improve hepatitis B and C testing uptake and treatment initiation in Ghana \u2013 A study protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4360-4747","authenticated-orcid":false,"given":"Vivian Efua","family":"Senoo-Dogbey","sequence":"first","affiliation":[{"name":"Public Health, University of Ghana, Legon, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6036-811X","authenticated-orcid":false,"given":"Gladys","family":"Dzansi","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Department of Adult Health, University of Ghana, Accra, Greater Accra Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica Charlotte","family":"Akpagloh","sequence":"additional","affiliation":[{"name":"Pantang Nursing and Midwifery College, Ghana Ministry of Health, Accra, Greater Accra Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Delali Adwoa","family":"Wuaku","sequence":"additional","affiliation":[{"name":"Department of Nursing Research, Korle Bu Teaching Hospital, Accra, Greater Accra Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Owusu Darkwa","sequence":"additional","affiliation":[{"name":"Department of Public Health Nursing, University of Ghana, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augustina Ama","family":"Boadu","sequence":"additional","affiliation":[{"name":"Ghana Prisons Service, University of Ghana, Accra, Greater Accra Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darko Ashiley","family":"Michael","sequence":"additional","affiliation":[{"name":"Department of Surgery, Korle-Bu Teaching Hospital, Korle Bu Teaching Hospital, Accra, Greater Accra Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edem Kojo","family":"Dzantor","sequence":"additional","affiliation":[{"name":"University of Ghana, Accra, Greater Accra Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prosper Junior","family":"Anatsui","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, University of Ghana, Accra, Greater Accra Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"2026012206102286000_16.1.e114815.1","unstructured":"European centre for disease prevention and control, European monitoring centre for drugs and drug addiction. 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