Experiences and care trajectories of persons living with Hepatitis B in Senegal: A qualitative study

Hepatitis B virus (HBV) infection is a public health concern in Senegal, where individuals encounter multifaceted barriers in their care trajectories. This qualitative study aimed to identify the individual, social, and structural determinants influencing HBV care delivery to inform targeted interventions for improving access. Between February and April 2021, we included 29 adults living with HBV from SEN-B, a prospective HBV cohort in urban Senegal providing biannual clinical monitoring for HBV-related liver complications. We conducted individual semi-structured interviews, during which participants shared their experiences about care trajectories. Through inductive analysis, we identified four primary factors that shape care trajectories: diagnostic circumstances, disclosure choices, social environment, and financial burden. Screening for HBV frequently occurred incidentally during blood donations, illness episodes, or prenatal care with inadequate post diagnosis communication adversely affecting disclosure decisions. While many participants disclosed their status to immediate family, some withheld information due to misconceptions about transmission risks and disease progression. The social environment played a dual role by favoring individuals' motivation to seek advice while also providing conflicting information, particularly regarding healthy and dietary practices. Financial constraints emerged as a critical barrier, limiting access to care and resulting in follow-up interruptions. Participants experienced significant delays between diagnosis and care engagement, often exacerbated by financial constraints or periods of being asymptomatic. The research highlights the complex care trajectories shaped by screening contexts, information quality, treatment availability, and financial barriers in Senegal. To mitigate these issues, it is crucial to raise public awareness, streamline care pathways, and establish effective monitoring systems. A coordinated, multi-sectoral approach involving all stakeholders is necessary to improve healthcare access and equity.