The World Health Organization has published new guidelines on testing for chronic HBV and HCV infection, supporting its Global Health Sector Strategy on Viral Hepatitis 2016-2021 and complementing guidance on prevention, care and treatment of chronic HCV and HBV infection published in 2016 and 2015, respectively . They represent full documentation to underpin a related Policy Brief published last November .
The guidelines lay down a public health approach to strengthening and expanding current testing practices for these infections and are intended primarily for public health agencies in low- and middle-income countries (LMICs), particularly in Asia and Africa, where the national burden of infection is disproportionately high and where hepatitis testing programmes are not yet well developed or where quality systems are lacking.
The introduction to the guidelines states, “Despite the high global burden of disease due to chronic hepatitis B and C infection, and the advances and opportunities for treatment, most people infected with HBV and/or HCV remain unaware of their infection and therefore frequently present with advanced disease. The extent of this hidden burden is poorly documented, and largely based on limited data from higher-income settings. However, in low-income settings, it is estimated that less than 5% are aware of their diagnosis. This contrasts with the considerable recent progress in HIV testing coverage, whereby now more than half of all people living with HIV globally are aware of their status.”
The new guidelines include sections covering recommended components of national strategy for LMICs, including:
- testing approaches – who to test for chronic hepatitis B and C infection
- testing strategy – how to test for chronic hepatitis B and C infection
- interventions to promote uptake of hepatitis testing and linkage to care
- implementation issues with regard to product selection and procurement, validation of test kits, and quality assurance.
In high-prevalence countries, the guidelines strongly recommend that testing be offered both to individuals within high-seroprevalence groups and those who have a history of exposure or high-risk behaviours for HBV or HCV infection. Thus for chronic HBV, the guidelines strongly recommend testing for pregnant women, some other specified risk groups, and blood donors. For chronic HCV, they recommend focused testing for adults and adolescents who are members of a high-prevalence group, and for adults and children “with a clinical suspicion of chronic viral hepatitis”.