Assessment of Knowledge, Stigmatizing Attitudes and Health-Seeking Behaviors Regarding Hepatitis B Virus Infection in a Pharmacy and Community Setting in Sierra Leone: A Cross-Sectional Study

Abstract

Hepatitis B virus (HBV) is a major global health challenge. Emerging evidence suggests that poor knowledge and stigma are impacting HBV control efforts in sub-Saharan Africa (SSA), but their role is not well understood. We conducted a cross-sectional study of adults aged ≥18 years in a community and pharmacy setting in Freetown, Sierra Leone. A structured questionnaire was used to assess knowledge, stigmatizing attitudes and health-seeking behaviors regarding HBV. Logistic regression was used to identify predictors of HBV knowledge and related stigma. A total of 306 adult participants were enrolled (50.7% male, 7.5% HBV positive and 11.7% vaccinated). Overall, 52.2% had good HBV knowledge and 49.3% expressed a stigmatizing attitude towards people with HBV. Notwithstanding, 72.2% stated they would receive the HBV vaccine if offered, 80.4% would take anti-HBV medication and 78.8% would be willing to attend clinic regularly. Good HBV knowledge was associated with HBV positive status (aOR 4.41; p = 0.029) and being vaccinated against HBV (aOR 3.30; p = 0.034). HBV-related stigma was associated with secondary or higher level of education (aOR 2.36; p < 0.001), good HBV knowledge (aOR 2.05; p = 0.006) and pharmacy setting (aOR 1.74, p = 0.037). These findings suggest that education and stigma reduction may benefit HBV elimination efforts in SSA.

Measuring Stigma Associated with Hepatitis B Virus Infection in Sierra Leone: Validation of an Abridged Berger HIV Stigma Scale

“…HBV-related stigma is common in SSA; however, only a small number of studies from the region have described individual and societal perceptions of the disease [11, 12, 14, 20, 21, 45]. Most of these are either qualitative studies which enrolled a small sample size or cross-sectional “knowledge, attitude and practices” studies which incorporated a few items to assess negative attitudes/perceptions of PWHB.…”

“…Survey questionnaire and stigma instrument development was informed by our experiences gained from interactions with PWHB in the clinical and community settings in Sierra Leone, our preliminary work describing the epidemiological, clinical and social aspects of the HBV epidemic in Sierra Leone [11,[29][30][31][32][33] and the broad literature on measuring HIV-related stigma [34,35], which has been adapted to inform studies in understanding HBV-related stigma [4,5].…”

“…The existing literature on HBV-related stigma is sparse and comes largely from developed countries, with little representation from SSA [4, 5]. The emerging evidence suggests that HBV-related stigma often arises from knowledge deficits and misconceptions of disease processes [4, 5, 9], although paradoxically, higher levels of knowledge especially of transmission dynamics has been associated with more societal stigma [10, 11]. Additionally, stigma serves as a major barrier to HBV status disclosure.…”

Measuring stigma associated with hepatitis B virus infection in Sierra Leone: Validation of an abridged Berger HIV stigma scale

“…Survey questionnaire and stigma instrument development were informed by our experiences gained from interactions with PWHB in the clinical and community settings in Sierra Leone, our preliminary work describing the epidemiological, clinical, and social aspects of the HBV epidemic in Sierra Leone 11,29–33 and the broad literature on measuring HIV‐related stigma, 34,35 which has been adapted to inform studies in understanding HBV‐related stigma 4,5 …”

“…The existing literature on HBV‐related stigma is sparse and largely comes from developed countries, with little representation from SSA 4,5 . The emerging evidence suggests that HBV‐related stigma often arises from knowledge deficits and misconceptions of disease processes, 4,5,9 although paradoxically, higher levels of knowledge especially of disease transmission dynamics has been associated with more societal stigma 10,11 . Additionally, stigma serves as a major barrier to HBV status disclosure.…”