INTRODUCTION Open Access
WHO guidelines on testing for hepatitis B
and C – meeting targets for testing
Margaret E. Hellard 1 ,2* , Roger Chou 3 and Philippa Easterbrook 4
Keywords: Viral hepatitis, Hepatitis C, Hepatitis B, Testing
An estimated 71 million people worldwide are chronic-
ally 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 Sustain-
able Development Goals (SDGs) [4]. The SDGs repre-
sent 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 em-
bedded across the SDGs. There is also a focus on inte-
gration 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 mem-
ber states, developed the first-ever Global health sector
strategy on viral hepatitis, 2016–2021, which was en-
dorsed by the World Health Assembly in May 2016 [5].
WHO’s vision is for “a world where viral hepatitis trans-
mission is halted and everyone living with viral hepatitis
has access to safe, affordable and effective prevention,
care and treatment services” [5]. The strategy also in-
cludes 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 esti-
mated that only a small proportion of persons with viral
hepatitis have been diagnosed - 9% of HBV-infected per-
sons (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.
New WHO testing guidelines
As part of this broader global response to viral hepatitis,
and to complement existing care and treatment guid-
ance for HBV [8] and HCV [9], WHO has now devel-
oped guidelines on hepatitis B and C testing for low and
middle-income countries (LMICs) [10] (Tables 2, 3, 4
and 5). In recognition of the need to substantially in-
crease viral hepatitis testing to meet the 2030 elimin-
ation targets (particularly in low and middle-income
countries), but also of the substantial cost to health bud-
gets of increased testing, the guidelines take an
evidence-based but pragmatic, low-cost approach. Their
primary target audience are policy makers responsible
for development of national hepatitis testing and treat-
ment programmes in LMICs. A particularly challenging
aspect in the guidelines’ development was the limited
direct quantity and quality of evidence available to guide
the development of recommendations [11] based on the
use of the GRADE process. In addition, very few rapid
* Correspondence: margaret.hellard@burnet.edu.au
1 Burnet Institute, 85 Commercial Road, Melbourne, Australia
2 The Alfred Hospital, Melbourne, Australia
Full list of author information is available at the end of the article
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The Author(s) BMC Infectious Diseases 2017, 17(Suppl 1):703
DOI 10.1186/s12879-017-2765-2