{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:35:37Z","timestamp":1787020537655,"version":"build-2736575974"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012446","name":"Akershus University Hospital","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012446","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Improving treatment uptake among people with chronic hepatitis B (CHB) infection who live outside urban centres is crucial to achieving the World Health Organization (WHO) elimination targets. Furthermore, as the number of deaths due to hepatitis B in Africa is rising, there is a need for new models of decentralized care adapted to the local context. The main aim of this study is to compare three different models of decentralized care for CHB treatment in Ethiopia, both from a clinical perspective and an implementation perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This will be prospective cohort study comparing three models of decentralized care for the management of CHB in Ethiopia. The first model (\u201cstandard model\u201d) utilizes the current WHO guidelines for CHB management. The second model (\u201csimplified model\u201d) offers treatment to all individuals with CHB except those with a completely normal baseline assessment, and the third model (\u201ctest-and-treat model\u201d) provides treatment to all individuals with CHB.<\/jats:p>\n                    <jats:p>The study will enroll 4,500 individuals with CHB over a one-year period across six study sites in Ethiopia. All patients will be followed up for 3 years, and the primary outcome is death or liver failure. The three models will be compared using a Cox proportional hazards regression model adjusting for potential confounders.<\/jats:p>\n                    <jats:p>Additionally, we will design adequate implementation strategies to address barriers and facilitators to implementation. We will design, implement and evaluate a policy toolbox that will ensure local adoption and implementation, using a co-creation approach, bringing together policymakers, politicians, healthcare personnel and patients, to come up with adequate policy implementation strategies for their contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>From a public health perspective, identifying a simple, feasible and effective model of decentralized CHB care would be a key step to reduce liver-related mortality on the African continent. This study may have important policy implications and is expected to inform national and international hepatitis B elimination efforts in low- and middle income countries (LMICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov, NCT06586983. Registered on September 4, 2024.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-025-13340-1","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T10:58:31Z","timestamp":1759229911000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Decentralization of hepatitis B care in sub-Saharan Africa: study protocol for a prospective cohort assessing three models of care in rural Ethiopia"],"prefix":"10.1186","volume":"25","author":[{"given":"Kristian Braathen","family":"Malme","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nega","family":"Berhe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fufa","family":"Hunduma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailemichael","family":"Desalegn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asgeir","family":"Johannessen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"13340_CR1","unstructured":"WHO. 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All participants will have to provide written informed consent prior to study enrollment. Important modifications of the protocol will be communicated to relevant parties. At the end of the study, the local hospitals will assume responsability for the patients, to ensure sustainability. Supply of drugs and diagnostics will be the responsability of the Ethiopian Ministry of Health.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All participants will have to provide written informed consent to participate in the study. Information regarding publication of results is included in the consent form.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Kristian Braathen Malme report personal lecture fees from Gilead and GSK. The other authors having nothing to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1223"}}