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BACKGROUND: Chronic hepatitis B is a leading cause of cirrhosis and hepatocellular carcinoma globally. In 2022, only 13% of the 254 million people with chronic hepatitis B were diagnosed and 3% were treated, highlighting a major gap in care provision. We aimed to comprehensively review service delivery models and their outcomes across the hepatitis B care cascade. METHODS: . This study is registered with PROSPERO (CRD42023410009). FINDINGS: =92·0%) after a median of 12 months on antiviral therapy (IQR 12-33). INTERPRETATION: Considerable attrition was seen across the chronic hepatitis B care cascade, with low rates of retention especially in patients not on antiviral therapy. Assessment for treatment eligibility and initiation of antiviral therapy were lower in primary versus hospital-based specialist care models. Chronic hepatitis B services need to adopt strategies to optimise linkage to care after diagnosis, initiation of antiviral therapy if eligible, adherence to antiviral therapy and retention in care, as promoted in 2024 WHO hepatitis B guidelines. Further research is also needed to explore simplified care models integrated with existing services to promote access. FUNDING: World Health Organization.
Stockdale et al. (Fri,) studied this question.