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

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.