Challenges and Opportunities of Human Immunodeficiency Virus, Hepatitis B Virus and Hepatitis C Virus Control and Elimination Policies, Regulations, and Strategies in Ethiopia
Mequanente Dagnaw, Bisrat Misganaw Geremew, Lemma Derseh GezieABSTRACT
Background
Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) remain major public health challenges globally and in Ethiopia. Although policies, regulations, and strategies have been developed to support their control and elimination, translating these policy commitments into effective implementation remains challenging. Understanding stakeholder experiences and perspectives is important for identifying gaps in policy awareness, participation, implementation, and program coordination.
Objective
This study aimed to explore the challenges and opportunities affecting the development, implementation, and effectiveness of HIV, HBV, and HCV control and elimination policies, regulations, and strategies in Ethiopia.
Methods
A facility‐ and institution‐based qualitative study was conducted among stakeholders involved in HIV, HBV, and HCV policy development, implementation, regulation, monitoring, research, and service delivery. Thirty‐four participants were purposively selected based on their professional roles, experience, knowledge, and involvement in relevant programs. Data were collected from April 17 to May 27, 2023, using qualitative interviews and focus group discussions, complemented by a review of relevant policy, strategy, guideline, and program documents and observations of selected service‐delivery and pharmaceutical settings. Data were transcribed, translated where necessary, and thematically analysed using MAXQDA Analytics Pro 2024. The analysis focused on policy awareness, stakeholder involvement, stakeholder roles, implementation status, opportunities, and challenges.
Results
Participants had a mean work experience of 16.82 years (SD = 0.79), and 30 (88.2%) were male. Of the 34 participants, 12 (35.3%) clearly identified or described the existence and key features of HIV, HBV, and HCV control and elimination policies, regulations, and strategies, while 22 (64.7%) did not. Fifteen (44.1%) participants reported stakeholder involvement in policy and strategy development, whereas 19 (55.9%) did not report adequate opportunities for participation. Most participants, 32 (94.1%), demonstrated an understanding of stakeholder roles and responsibilities in policy development and implementation. However, only 8 (23.5%) participants reported a clear current implementation status or progress, while 26 (76.5%) reported no clear implementation status. Twenty‐nine (85.3%) participants reported limited or unclear opportunities for strengthening HIV, HBV, and HCV control and elimination. Nearly all participants, 32 (94.1%), identified challenges affecting policy and strategy implementation, including COVID‐19‐related disruptions and concerns regarding the translation of policies and strategies into practice.
Conclusion
The findings indicate a substantial gap between recognition of stakeholder responsibilities and the practical awareness and implementation of HIV, HBV, and HCV control and elimination policies, regulations, and strategies in Ethiopia. Strengthening policy dissemination, inclusive stakeholder engagement, implementation monitoring, coordination, and the translation of policy commitments into service‐delivery activities may support progress toward national and global elimination targets. Sustainable financing, strengthened health‐system capacity, stakeholder accountability, and reliable monitoring and evaluation systems are important considerations for improving implementation.