The first global systematic review and meta-analysis of hepatitis B care has found critical patient losses at every step of care, calling for decentralised, integrated models to improve diagnosis, treatment, and patient retention.
Published in The Lancet Gastroenterology & Hepatology, the findings reveal that current hepatitis B service delivery models are failing to keep patients engaged in lifelong care – threatening the world’s ability to meet the World Health Organisation (WHO) 2030 hepatitis B elimination goals.
The WHO-commissioned review was conducted by researchers from the University of Liverpool and Imperial College London in collaboration with colleagues from The Gambia, India, the Philippines, the USA, and Vietnam. It analysed data from more than 1.7 million people with chronic hepatitis B across 50 countries and found significant drop-offs in diagnosis, treatment initiation, and long-term retention, even in the best-performing systems.
Key findings of the review show that:
- Specialist-led hospital care achieved the best results but still showed major gaps: fewer than 75% of patients were assessed for treatment eligibility; of those eligible, only 78% began therapy. Retention plummeted among those not receiving treatment.
- Primary care, co-managed care, and passive referral models fared worse, with lower rates of assessment, initiation of care, and retention once in care.
- Postpartum care for women diagnosed during antenatal care had particularly low follow-up rates.
- Community screening with active linkage to specialist care achieved high treatment initiation rates for eligible patients.
The researchers have made the following recommendations:
- Decentralise care into primary health facilities and integrate with HIV/non-communicable disease (NCD) clinics.
- Remove financial barriers by eliminating out-of-pocket costs for testing and treatment.
- Accelerate access through same-day assessment and treatment initiation.
- Improve long-term engagement using adherence and retention strategies from HIV care programmes.
