Global Review Highlights Need to Transform Hepatitis B Care to Achieve WHO 2030 Goals

A comprehensive global analysis has revealed significant gaps in hepatitis B care delivery worldwide, emphasizing the necessity for overhauling current models to meet the World Health Organization's (WHO) hepatitis B elimination targets set for 2030. The first systematic review and meta-analysis of its kind, published in The Lancet Gastroenterology & Hepatology, assessed data from over 1.7 million individuals across 50 countries. Despite progress in certain healthcare settings, the study identified substantial patient attrition at every stage of care, from diagnosis to treatment and long-term retention.

Findings demonstrate that specialist-led hospital care remains the most effective in managing hepatitis B, with over 75% of patients assessed for treatment eligibility and 78% of eligible individuals initiating therapy. Nonetheless, retention declines sharply among those not on treatment. Models relying solely on primary care or passive referral systems perform noticeably worse, with lower assessment and retention rates, especially among postpartum women diagnosed during pregnancy.

Community screening paired with active linkage to specialist services shows promise, achieving high rates of treatment initiation among eligible patients. However, overall health systems still face critical challenges in maintaining engagement over time. Lead author Dr. Alexander Stockdale from the University of Liverpool emphasizes that without urgent changes, millions will continue to be missed by lifesaving interventions. Strengthening primary care in low- and middle-income countries is pivotal, particularly as hepatitis B-related mortality was estimated at 1.1 million in 2022.

Experts from Imperial College London and other collaborating institutions highlight that although recent WHO guidelines expanded treatment eligibility, merely simplifying criteria is insufficient. There is a pressing need for decentralizing hepatitis B services, integrating them into existing HIV and chronic disease clinics, and removing financial barriers to testing and treatment. Implementing same-day assessments and initiating treatment promptly, alongside adopting retention strategies from HIV programs, could vastly improve patient outcomes.

Given the reductions in international funding, especially through USAID and PEPFAR, the study urges policymakers to adopt more accessible and scalable care models to accelerate progress towards hepatitis B elimination by 2030.