Decentralization of hepatitis B care in sub-Saharan Africa: study protocol for a prospective cohort assessing three models of care in rural Ethiopia
Bibliographic record
Abstract
BACKGROUND: 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. METHODS: This will be prospective cohort study comparing three models of decentralized care for the management of CHB in Ethiopia. The first model (“standard model”) utilizes the current WHO guidelines for CHB management. The second model (“simplified model”) offers treatment to all individuals with CHB except those with a completely normal baseline assessment, and the third model (“test-and-treat model”) provides treatment to all individuals with CHB. 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. 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. DISCUSSION: 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). TRIAL REGISTRATION: ClinicalTrials.gov, NCT06586983. Registered on September 4, 2024.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.014 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.029 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".