Full hepatitis B and C virus (HBV/HCV) prevention programs that combine screening, vaccination, and early treatment can improve detection rates and reduce liver-related deaths, according to a systematic review recently published in Public Health.
Screening Detects Hidden Infections
Chronic HBV and HCV infections remain leading causes of hepatocellular carcinoma and long-term liver disease, necessitating prevention strategies that go beyond basic infection control. While direct-acting antivirals have transformed HCV treatment, gaps persist in identifying undiagnosed infections and ensuring timely care.
Researchers evaluated the effectiveness of HBV/HCV prevention programs in high-income countries, focusing on strategies such as population-based screening, targeted outreach, vaccination, and ongoing surveillance. The analysis included studies published between January 2013 and November 2025, covering a wide range of care models and implementation approaches.
Across 23 studies, community-based screening initiatives targeting populations at raised risk identified undiagnosed HBV/HCV infections in 15.3% to 34.3% of screened individuals. Integrated care pathways and monitoring programs enabled the detection of advanced fibrosis in 5.3% to 46.2% of participants and HCC in 3.5% to 39.2% of cases.
Successful programs frequently utilized multidisciplinary models combining primary care, specialty care, community organizations, and case management. These initiatives incorporated point-of-care testing, noninvasive liver assessments, vaccination, antiviral therapy, and patient navigation services to improve linkage to care.
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Economic Benefits and Outcomes
The review found that earlier diagnosis and treatment were associated with improved long-term liver outcomes. One population-based analysis included in the review found that individuals with cirrhosis had a 2.74-fold higher risk of developing HCC, whereas individuals who achieved sustained virologic response following HCV treatment experienced an 82% reduction in HCC risk.
Modeling studies also demonstrated potential population-level benefits. In Australia, expanded screening, access to antiviral treatment, and monitoring between 2015 and 2022 were estimated to prevent 969 HCV-related HCC cases and 1427 HCV-related deaths. Economic analyses consistently supported the value of prevention programs, with incremental cost-effectiveness ratios ranging from $1890 to $187,000 per quality-adjusted life-year gained.
Despite these evidence-based benefits, implementation barriers continue to limit program effectiveness. The review identified fragmented health care delivery, limited workforce capacity, inadequate harm-reduction services, unstable funding, incomplete patient data systems, and competing clinical priorities as significant challenges.
Patient-level barriers also affected treatment initiation and long-term monitoring. Limited hepatitis awareness, stigma, socioeconomic instability, and difficulties maintaining follow-up contributed to gaps in care.
Programs demonstrating greater success incorporated accessible and subsidized testing and treatment, coordinated care pathways, automated health record reminders, and partnerships between health systems and community organizations. The authors concluded that hepatitis prevention efforts must extend beyond identifying infections by incorporating full care models spanning diagnosis, treatment, and surveillance.
