University of Liverpool study warns global hepatitis B care models are failing patients and threaten WHO 2030 elimination goal

University of Liverpool study warns global hepatitis B care models are failing patients and threaten WHO 2030 elimination goal

(IN BRIEF) The University of Liverpool and Imperial College London, working with international partners, have published the first global systematic review of hepatitis B care, commissioned by WHO and covering over 1.7 million patients across 50 countries. The analysis found significant losses at every stage of the care pathway, including diagnosis, treatment initiation, and long-term retention. Even specialist-led hospital systems showed gaps, with fewer than 75% assessed for treatment eligibility and only 78% of eligible patients beginning therapy. Primary care and referral-based models performed worse, and postpartum follow-up rates were especially low. Researchers call for decentralised and integrated approaches, linking hepatitis B care with primary health, HIV, and chronic disease services, alongside removing financial barriers and fast-tracking treatment initiation. Without urgent reforms, the world risks falling short of the WHO goal to eliminate hepatitis B by 2030.

(PRESS RELEASE) LIVERPOOL, 20-Aug-2025 — /EuropaWire/ — A landmark global review and meta-analysis has revealed serious gaps in hepatitis B care worldwide, showing that patients are being lost at every stage of the treatment pathway. The study, published in The Lancet Gastroenterology & Hepatology and commissioned by the World Health Organization (WHO), warns that current care models are failing to keep patients engaged in lifelong treatment — a challenge that could derail the WHO target of eliminating hepatitis B as a public health threat by 2030.

The review was led by researchers at the University of Liverpool and Imperial College London in collaboration with partners from The Gambia, India, the Philippines, the USA, and Vietnam. It analysed data from more than 1.7 million people across 50 countries, offering the first comprehensive global picture of hepatitis B service delivery. Despite some encouraging results, the findings show major drop-offs in diagnosis, treatment initiation, and long-term patient retention, even within the best-performing healthcare systems.

Key results revealed that specialist-led hospital care produced the highest overall outcomes, yet fewer than three-quarters of patients were assessed for treatment eligibility, and of those who qualified, just 78% began therapy. Retention rates dropped sharply among those not started on antivirals. Outcomes were worse in primary care, shared-care, or passive referral systems, where assessment, initiation, and retention were all lower. Particularly concerning were follow-up rates for women diagnosed during pregnancy, which were among the lowest across all groups. In contrast, community-based screening combined with active linkage to specialist care achieved strong results in treatment initiation among eligible patients.

Dr Alexander Stockdale of the University of Liverpool, lead author of the study, emphasized the implications: “This is the first global review to map progress across the hepatitis B care pathway. Without urgent changes, millions will miss out on lifesaving treatment. Many patients are not being assessed properly or started on antivirals, and too many are lost to follow-up. Strengthening primary care in low- and middle-income countries is critical if we are to prevent further hepatitis B-related deaths, which already numbered 1.1 million in 2022.”

Senior author Professor Philippa Easterbrook of Imperial College London (and formerly WHO Global Hepatitis Programme) noted that WHO’s 2024 guidelines were a key step forward, expanding treatment eligibility to nearly half of all patients with chronic hepatitis B. However, she warned that simplifying criteria is not enough: “Services are still inaccessible for many, and even where clinics exist, patients are falling through the cracks. We need to integrate hepatitis B into primary care or existing HIV and chronic disease programmes, using lessons from HIV, where streamlined models have achieved over 90% diagnosis, treatment, and retention.” She also underlined the urgency of action given recent reductions in global health funding through USAID and PEPFAR.

The researchers recommend decentralising hepatitis B services into primary health facilities, integrating care into existing HIV and non-communicable disease clinics, eliminating out-of-pocket expenses for testing and treatment, accelerating access with same-day assessment and initiation of therapy, and applying proven HIV strategies for long-term adherence and retention.

The study underscores the urgent need to reform hepatitis B care delivery worldwide, warning that without substantial change, elimination targets will remain out of reach.

Click here to read the full review.

Media Contacts:

Joanne Carr
Deputy Director of Communications and Public Affairs
T: +44 (0)7825 434900
E: jocarr@liverpool.ac.uk

Sarah Stamper
Media Relations Manager – Science and Engineering
T: +44 (0)7970 247396
E: sarah.stamper@liverpool.ac.uk

Jennifer Morgan
Media Relations Manager – Health and Life Sciences
T: +44 (0)7775 547589
E: J.L.Morgan@liverpool.ac.uk

Alison Cornmell
Media Relations Manager – Health and Life Sciences
T: +44 (0) 7771 700680
E: Alison.Cornmell@liverpool.ac.uk

SOURCE: University of Liverpool