WHO guidelines on testing for hepatitis B and C – meeting targets for testing

An estimated 71 million people worldwide are chronically infected with hepatitis C [1] and 257 million with hepatitis B [1–4]. Combined, hepatitis C and hepatitis B are estimated to cause 1.34 million deaths annually, and viral hepatitis is now the 7th leading cause of death globally, ahead of HIV and malaria [2, 3]. The burden of hepatitis B and C disease in 2013 was estimated at 38.7 million disability-adjusted life years (DALYs), an increase of at least 25% since 1990 [3, 4]. In late 2015, world leaders adopted the 2030 Agenda for Sustainable Development, which contains 17 Sustainable Development Goals (SDGs) [4]. The SDGs represent a shift away from the disease–specific goals of the Millennium Development Goals (MDG) era and have adopted an approach where health related goals are embedded across the SDGs. There is also a focus on integration and the aspiration of universal health insurance cover. SDG 3.3 aims to ensure healthy lives and promote well-being at all ages, and highlights the need to combat viral hepatitis [4] (Table 1). In response to the SDGs, the World Health Organization (WHO), working with member states, developed the first-ever Global health sector strategy on viral hepatitis, 2016–2021, which was endorsed by the World Health Assembly in May 2016 [5]. WHO’s vision is for “a world where viral hepatitis transmission is halted and everyone living with viral hepatitis has access to safe, affordable and effective prevention, care and treatment services” [5]. The strategy also includes targets for the elimination of hepatitis B and C as public health threats a 90% reduction in new chronic infections and a 65% reduction in mortality by 2030 from 2015 levels [5]. Achieving these targets will require reaching ambitious service coverage milestones across seven prevention and care interventions, that includes diagnosing 80% of people with chronic viral hepatitis by 2030 and treating eight million people by 2020, and 80% of those eligible for treatment by 2030. These targets are ambitious but achievable. However it is crucial to considerably increase the number of people being tested for viral hepatitis and who are aware of their status if the treatment targets are to be met and the elimination agenda advanced. Currently, it is estimated that only a small proportion of persons with viral hepatitis have been diagnosed 9% of HBV-infected persons (22 million), and 20% of HCV-infected persons (14 million) globally [1] with the majority diagnosis, and treatments, occuring in higher income settings [6, 7]. In many LMICs, it is estimated that less than 1% of those infected have been diagnosed and treated.