Getting the Hepatitis B Birth Dose Vaccine to Every Baby: A Rapid Scoping Review of Birth Dose Vaccine Delivery Strategies in Out-of-Facility Settings

Background/Objectives: Globally, coverage of the hepatitis B vaccine within 24 h of birth is 45 percent, far below the WHO target of 90 percent by 2030. For newborns delivered in out-of-facility settings, delayed contact with health workers, transportation barriers, and cold chain constraints can impede timely vaccination. This review explores strategies and facilitators for delivering birth dose vaccines to infants born outside of health facilities in low- and middle-income countries. Methods: A rapid scoping review was conducted, searching PubMed and targeted websites for peer-reviewed and gray literature published between 2005 and 2025. Data were charted using a standardized extraction tool. Frequency and thematic analyses were conducted. Results: After screening 315 studies, 26 eligible sources were identified. Delivery strategies consisted of three components: identifying and tracking home births; supporting caregiver uptake through education, reminders, or incentives; and delivering the vaccine through home-based administration or referral to facilities. Sub-components included pregnancy and birth notification systems, postnatal home visits, mobile reminders, incentives, and home-based vaccination by facility or community providers. The feasibility of these strategies was shaped by factors across system levels, such as national policies and financing; health system infrastructure; cold chain capacity; health workforce configuration; caregiver awareness; and community social norms. In several contexts, flexible cold chain approaches and vaccine administration by community-based cadres enabled timely vaccination of infants born at home. Conclusions: Vaccination programs can learn from existing out-of-facility vaccine delivery approaches to strengthen hepatitis B birth dose vaccination programs for timely and equitable coverage.