Policy analysis evaluates tele-mentoring's impact on hepatitis B management in primary care, suggesting effective capacity building in resource-limited settings.
Hepatitis B virus (HBV) is a major public health burden in The Gambia, with specialist care concentrated in urban centres. Primary care practitioners often lack the specific training to manage chronic HBV effectively. Tele-mentoring programmes present a potential policy solution to build capacity and decentralise care. This policy analysis evaluated the adoption and clinical outcomes of a Project ECHO tele-mentoring programme designed to train Gambian primary care doctors in chronic hepatitis B management. A mixed-methods policy analysis was conducted. Quantitative data on clinician participation and self-reported confidence were collected. Qualitative data from semi-structured interviews with participating doctors and facilitators assessed perceived utility, barriers to adoption, and perceived impact on patient care. The programme demonstrated high adoption, with a large majority of enrolled primary care doctors completing the course. Qualitative analysis revealed a dominant theme of increased clinician confidence in managing HBV, including serology interpretation and indications for antiviral therapy. However, structural barriers, such as inconsistent drug supply and lack of dedicated clinic time, constrained the implementation of new knowledge. Project ECHO is a feasible model for building HBV management capacity among Gambian primary care doctors. It improved self-reported clinician competence, aligning with national goals to decentralise specialist care. Policy should support integrating tele-mentoring into continuous professional development. Scaling up must be coupled with health systems strengthening to address drug supply and clinic infrastructure barriers. Further research is needed to measure long-term patient-level clinical outcomes. telemedicine, capacity building, hepatitis B, primary health care, The Gambia, health policy, tele-mentoring This analysis provides evidence for policymakers on the potential and limitations of tele-mentoring as a strategy to decentralise hepatitis B care in a resource-limited setting.
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Jallow et al. (2016) studied this question.
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