Consolidated guidance on hepatitis B and C prevention, testing, treatment, service delivery and monitoring

What this guideline says

GMJ summary

This WHO consolidated guidance brings together over 80 evidence-informed recommendations for hepatitis B and C prevention, testing, treatment, service delivery and monitoring developed between 2015 and 2025. It is the first publication to integrate all hepatitis B, C and D guidelines into a single reference document, providing practical implementation considerations using a public health approach. The guidance aims to reduce fragmentation, enhance usability and accelerate scale-up of effective interventions to achieve the global target of eliminating viral hepatitis as a public health threat by 2030.

The publication covers the full continuum of care: primary prevention (including timely hepatitis B birth-dose vaccination, preventing vertical transmission, blood safety, infection control and harm reduction); testing and diagnosis strategies (targeted and general population approaches, rapid and point-of-care diagnostics, reflex testing); treatment (pangenotypic direct-acting antivirals for hepatitis C cure, long-term nucleoside analogues for hepatitis B suppression); and simplified service delivery (decentralization, integration with primary health care and HIV/TB services, task-sharing). It emphasizes person-centred, differentiated care models adaptable to diverse health system contexts, especially in low- and middle-income countries.

Key principles include equity in access, informed consent, confidentiality, community engagement and adaptation to local epidemiology and resources. The guidance provides specific dosing, monitoring schedules and eligibility criteria throughout, alongside algorithms, patient management templates and indicators for programme monitoring.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. All infants should receive hepatitis B vaccine birth dose within 24 hours of birth, followed by 2–3 additional doses to complete the primary series
2. All pregnant women should be tested for HBsAg; those with HBV DNA ≥200 000 IU/mL (or all HBsAg-positive where DNA testing unavailable) receive tenofovir disoproxil fumarate prophylaxis from second trimester until at least delivery
3. Treat adults/adolescents with chronic hepatitis B if: significant fibrosis (APRI >0.5 or FibroScan® >7 kPa) or cirrhosis (APRI >1.0 or FibroScan® >12.5 kPa); or HBV DNA >2000 IU/mL plus ALT above upper limit of normal (30 U/L men, 19 U/L women); or coinfections/comorbidities
4. First-line hepatitis B treatment: tenofovir disoproxil fumarate or entecavir for all adults, adolescents and children ≥2 years; treatment is lifelong for those with cirrhosis
5. Treat all adults, adolescents and children ≥3 years with chronic hepatitis C using pangenotypic direct-acting antivirals: sofosbuvir + daclatasvir (12 weeks), sofosbuvir + velpatasvir (12 weeks) or glecaprevir + pibrentasvir (8 weeks)
6. In settings with ≥2% HBsAg or HCV antibody seroprevalence, offer routine testing to all adults and adolescents with linkage to care; focused testing for key populations (people who inject drugs, prisoners, sex workers, men who have sex with men, healthcare workers) in all settings
7. Reflex HBV DNA or HCV RNA testing following positive serology (laboratory-based using stored sample or clinic-based with immediate collection) improves linkage to care; point-of-care molecular assays can be used as alternatives to laboratory-based testing
8. People who inject drugs should have access to sterile needles/syringes (300 per person per year by 2030) and opioid agonist maintenance therapy; all healthcare injections must use new sterile needle and syringe; all blood donations screened for HBsAg and HCV antibodies

Key programmatic interventions for viral hepatitis elimination and coverage targets for 2025 and 2030

Table extracted from the guideline

Source: World Health Organization, Consolidated guidance on hepatitis B and C prevention, testing, treatment, service delivery and monitoring. Reproduced in summary form.

What changed in this edition

Versus the previous edition

• 2024 update includes universal tenofovir disoproxil fumarate prophylaxis for all HBsAg-positive pregnant women in settings without HBV DNA testing (previously only for those with DNA ≥200 000 IU/mL)
• Expanded hepatitis B treatment eligibility: now includes HBV DNA 2000–20 000 IU/mL with elevated ALT (previously threshold was >20 000 IU/mL); added treatment indication for persistently abnormal ALT alone when HBV DNA testing unavailable
• New 2024 recommendations for hepatitis D testing: universal anti-HDV antibody testing for all HBsAg-positive individuals as preferred approach, or focused testing in resource-limited settings
• Updated point-of-care testing recommendations: HBV DNA and HCV RNA point-of-care assays can be used as alternatives to laboratory-based testing for diagnosis and monitoring
• Reflex testing strategies formalized for HBV DNA, HCV RNA and anti-HDV to improve linkage to care
• Expanded direct-acting antiviral treatment recommendations to children as young as 3 years (previously 6 years minimum)

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

Related on GMJ

Interconnected resources

GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.