MADRID, 20 (EUROPA PRESS)
An international team of researchers led by the University of Liverpool and Imperial College London (UK) has highlighted the need to modernize care for patients with hepatitis B, after finding that current models fail to retain patients in lifelong care, threatening the World Health Organization (WHO) goal of eliminating the disease by 2030.
The results of the study, commissioned by the WHO and published in The Lancet Gastroenterology & Hepatology, have shown that each stage of disease care suffers "critical losses" of patients.
"This is the first global review to analyze our progress in the hepatitis B care continuum. Without urgent changes, millions of people will lose access to life-saving treatments. Many patients are not being fully assessed or started on antivirals when they could benefit, and many are lost to follow-up over time," said Alexander Stockdale, lead author of the article and a member of the University of Liverpool.
He also stressed the importance of strengthening primary care in low- and middle-income countries to prevent hepatitis B-related deaths, which were already estimated at 1.1 million by 2022.
Although specialist-led hospital care has achieved the best results, it still has "significant shortcomings." Fewer than 75 percent of patients have been evaluated for treatment eligibility, and of those eligible, only 78 percent have actually started therapy.
The research found that patient retention plummets among those not receiving treatment, with primary care, co-managed care, and passive referral models having the worst outcomes, with lower rates of assessment, initiation of care, and retention once in care.
Postpartum care for women diagnosed during prenatal care has also yielded "particularly low" follow-up rates, while community screening with active linkage to specialist care has achieved high treatment initiation rates for eligible patients.
“The 2024 WHO guidelines were a major step forward, expanding treatment eligibility to nearly half of people with chronic hepatitis B. However, simplifying the criteria alone is not enough. Too many people still lack access to services, and even where clinics exist, patients are often excluded,” explained lead author Philippa Easterbrook of Imperial College London.
Following this, he emphasized the importance of establishing "simple and decentralized" models that integrate hepatitis B into primary care or existing services for the human immunodeficiency virus (HIV) and other chronic diseases.
"The HIV response has shown that optimized care can achieve more than 90 percent diagnosis, treatment initiation, and retention rates. It's time to apply these lessons to hepatitis B," he added.
Similarly, he has advocated for an integrated approach, something "even more urgent" following the recent reductions in funding by the United States for health programs in low- and middle-income countries.
Other measures proposed by experts to address the situation include removing financial barriers by ending out-of-pocket costs for testing and treatment; accelerating access through same-day screening and treatment initiation; and improving long-term participation through adherence and retention strategies for HIV care programs.
In collaboration with researchers from Gambia, India, the Philippines, the United States, and Vietnam, we analyzed data from more than 1.7 million people with chronic hepatitis B in 50 countries, detecting declines in diagnosis, treatment initiation, and long-term retention, even in the best-performing systems.
