Evaluating the Adoption and Clinical Outcomes of a Tele-Mentoring Programme (Project ECHO) for Hepatitis B Management by Primary Care Practitioners in The Gambia: An Action Research Study

Hepatitis B virus (HBV) infection is a major public health burden in The Gambia. Primary care practitioners are central to its management but often lack specialist knowledge and confidence. The Project ECHO tele-mentoring model presents a potential strategy for building clinical capacity through case-based learning and specialist support. This action research study aimed to evaluate the adoption of a Project ECHO programme for HBV management by primary care practitioners in The Gambia and to assess its influence on clinical practices and patient outcomes. A participatory action research approach was employed over multiple cycles. Participants were primary care practitioners from urban and rural clinics. Data were collected through pre- and post-programme surveys on knowledge and self-efficacy, focus group discussions on adoption barriers and facilitators, and analysis of aggregated, anonymised patient data on key clinical indicators. Practitioners reported significantly increased confidence in managing HBV, with a high proportion indicating improved ability to interpret diagnostic tests. Qualitative data highlighted the value of a supportive community of practice and identified inconsistent internet connectivity as a key challenge. Preliminary analysis of patient data indicated a positive trend in the proportion of patients receiving guideline-concordant monitoring. The Project ECHO model is a feasible and acceptable intervention for building HBV management capacity among primary care practitioners in The Gambia. It fostered a collaborative learning environment that enhanced practitioner confidence and appears to have influenced clinical practice positively. Tele-mentoring should be integrated into national continuous professional development frameworks. Future scale-up requires strategies to improve digital infrastructure and should consider hybrid delivery models to mitigate connectivity issues. tele-mentoring, Project ECHO, hepatitis B, capacity building, primary care, The Gambia, action research This study provides novel evidence on the implementation and potential impact of a tele-mentoring network for hepatitis B management in a sub-Saharan African primary care context.