Hepatitis B and C: excerpts from WHO guidance, 2026

Disclaimer: This post is for academic purposes only. Please read the original document if you intend to use them for clinical purposes.

This document summarises the 2026 WHO guidelines for the elimination of viral hepatitis as a public health threat by 2030. The strategy focuses on a public health approach that prioritizes person-centred care, simplified service delivery, and integration into primary health care (PHC).

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1. Strategic Framework for Elimination:

The global response is guided by the Global Health Sector Strategy (2022–2030), which integrates viral hepatitis with HIV and sexually transmitted infection (STI) frameworks.

1.1 Strategic Directions:

The strategy is built upon 5 pillars:

1. High-quality services: Delivering evidence-informed, person-centred care.
2. System optimization: Strengthening sectors and partnerships.
3. Data-driven action: Using strategic information to guide decisions.
4. Community engagement: Empowering civil society and affected populations.
5. Innovation: Fostering new technologies for greater impact.

1.2 Path-to-Elimination Framework:

To recognize country progress, WHO utilizes a tiered system (Bronze, Silver, Gold) based on service coverage and impact targets:

• Impact Targets: HBsAg seroprevalence ≤ 0.1% in children under five; HCV incidence ≤ 5 per 100,000; and a combined mortality rate ≤ 6 per 100,000.
• Programmatic Targets: 90% diagnosis rate, 80% treatment rate, and 90% HBV birth-dose coverage.

2. Primary Prevention Strategies:

Prevention focuses on interrupting transmission through vaccination, medical safety, and harm reduction.

2.1 Elimination of Mother-to-Child Transmission (EMTCT):

HBV is primarily transmitted perinatally or through early childhood exposure:

• Vaccination: All infants must receive a hepatitis B vaccine dose as soon as possible after birth (within 24 hours), followed by 2–3 additional doses.
• Maternal Screening: Universal testing for HBsAg, HIV, and syphilis for all pregnant women.
• Prophylaxis: For HBsAg-positive pregnant women with high viral loads (HBV DNA ≥ 200,000 IU/mL or HBeAg positive), Tenofovir Disoproxil Fumarate (TDF) is recommended from the second trimester.

2.2 Harm Reduction for Key Populations:

Harm reduction is essential for populations such as people who inject drugs (PWID):

• Needle and Syringe Programmes (NSP): Access to sterile equipment and low dead-space syringes.
• Opioid Agonist Maintenance Therapy (OAMT): Recommended for opioid-dependent individuals, including those in prisons.

2.3 Clinical and Blood Safety:

• Injection Safety: Use of safety-engineered syringes (sharps injury protection and reuse prevention features).
• Blood Safety: Mandatory screening of all blood donations for HIV, HBV, HCV, and syphilis.

3. Testing and Diagnosis Framework:

Testing approaches have been simplified to facilitate better linkage to care and reduce the diagnostic gap:

3.1 Testing Criteria:

3.2 Diagnostic Innovations:

• Reflex Testing: Immediate HBV DNA or HCV RNA testing following a positive serological result to promote faster treatment initiation.
• Self-Testing: Recommended as an additional approach for HCV to increase uptake.
• Point-of-Care (POC) Testing: Use of POC nucleic acid testing (NAT) as an alternative to laboratory-based assays.
• Dried Blood Spots (DBS): May be used for serology and NAT in settings with poor venous access or limited laboratory infrastructure.

3.3 Hepatitis D virus (HDV) testing:

HDV affects approximately 5% of those with chronic HBV (12 million people) and accelerates disease progression.

• Approach: Serological testing for anti-HDV antibodies for all HBsAg-positive individuals, followed by HDV RNA NAT to confirm viraemic infection.

4. Clinical Management and Treatment:

4.1 Hepatitis B virus (HBV) management:

HBV treatment is generally lifelong and aims to prevent cirrhosis and hepatocellular carcinoma (HCC).

• Eligibility (2024 Update):
  • Significant fibrosis (≥ F2) or Cirrhosis (F4) (regardless of HBV DNA or ALT levels) OR
  • HBV DNA >2000 IU/mL and elevated ALT OR
  • Presence of any of the following (regardless of APRI score, HBV DNA or ALT level):
    • Coinfections (HIV, HCV, HDV),
    • family history of HCC, or
    • extrahepatic manifestations. OR
  • Persistently abnormal ALT levels alone (in absence of access to HBV DNA assay)
• Preferred Regimens: Nucleos(t)ide analogues with high genetic barriers to resistance: Tenofovir Disoproxil Fumarate (TDF) or Entecavir

4.2 Hepatitis C virus (HCV) management:

HCV treatment is curative and uses pangenotypic direct-acting antivirals (DAAs).

• Eligibility: All adults, adolescents, and children ≥ 3 years, regardless of disease stage.
• Recommended Regimens:
  • Sofosbuvir + Daclatasvir (12 weeks)
  • Sofosbuvir + Velpatasvir (12 weeks)
  • Glecaprevir + Pibrentasvir (8 weeks)
• Cure Validation: Sustained Virological Response (SVR) documented by HCV RNA NAT at 12 or 24 weeks post-treatment.

5. Simplified Service Delivery:

To reach elimination targets, the guidelines advocate for a shift from specialist-led, centralized care to a decentralized, integrated public health model.

• Decentralization: Delivering testing and treatment at peripheral facilities, harm reduction sites, and prisons.
• Integration: Co-locating hepatitis services with HIV, TB, antenatal care, and primary health care.
• Task Sharing: Training non-specialist doctors and nurses to manage diagnosis and treatment, supported by mentoring and clear referral pathways for complex cases.
• Person-Centred Care: Organizing services around the needs of the individual and community, ensuring informed consent and actively reducing stigma and discrimination.

6. Enabling Factors for Implementation:

Successful scale-up requires addressing structural and systemic barriers:

• Financing: Mobilizing domestic resources and including hepatitis services in national essential health benefit packages.
• Procurement: Utilizing international pooled procurement mechanisms (e.g., UNICEF, Global Fund) and registering WHO-prequalified generic products to lower commodity costs.
• Strategic Information: Strengthening person-centred data systems to track the cascade of care (diagnosis, treatment initiation, and SVR/viral suppression).
• Digital Health: Leveraging telemedicine and digital platforms to support PHC workers in delivering high-quality care.

_{Citation: Consolidated guidance on hepatitis B and C prevention, testing, treatment, service delivery and monitoring: an implementation handbook for a public health approach. Geneva: World Health Organization; 2026. Licence: CC BY-NC-SA 3.0 IGO.}