Completion of Hepatitis B Vaccination Schedule Among Healthcare Workers in Four Counties in Kenya: A Mixed-Methods Study

Abstract

Background/Objectives: Healthcare workers (HCWs) are at an increased risk of hepatitis B virus infection through occupational exposure, yet completion of the recommended hepatitis B vaccination schedule remains suboptimal in Kenya. We assessed vaccination completion, associated factors, motivators, and barriers among HCWs. Methods: We conducted a mixed-methods study combining a cross-sectional survey of 1614 HCWs in 178 health facilities across Kakamega, Nakuru, Mombasa, and Siaya counties with nine focus group discussions. The survey was conducted in August–September 2023 and the focus groups during June 2024–January 2025. Mixed-effects logistic regression with a random intercept for health facility was used to identify factors associated with completion of three vaccine doses, and qualitative data were analyzed thematically. Results: Among 1583 HCWs with a known vaccination status, 700 (44.2%; 95% CI: 41.8–46.7) reported completing three doses, 410 (25.9%) had received one or two doses, and 473 (29.9%) had never been vaccinated. The main motivator was self-protection (71.7%). Common barriers were vaccine unavailability (57.5%), lack of knowledge (28.8%), the vaccine not being offered on site (28.2%), and cost (17.4%). Completion was more likely among male HCWs, those working in urban areas facilities, and those with 6–10 or 11–20 years of healthcare work experience, and less likely among support staff, administrative staff, clinicians and allied health professionals than among nurses/midwives. Conclusions: Fewer than half of HCWs reported completing the three-dose hepatitis B vaccination schedule. Improving vaccine availability, reducing out-of-pocket costs, strengthening dose-reminder systems, and addressing knowledge gaps may improve completion among HCWs in the study counties.