Hepatitis Prevention Programs Improve Liver Outcomes, but Gaps in Screening, Care Remain

Hepatitis B and C virus (HBV/HCV) prevention programs incorporating screening, vaccination, early treatment, and long-term monitoring can improve detection, treatment uptake, and liver-related outcomes, according to a systematic review recently published in Public Health.¹

Assessing the Impact of HBV/HCV Prevention Programs

Chronic HBV and HCV infections remain leading causes of hepatocellular carcinoma (HCC) and long-term liver disease, highlighting the need for prevention strategies that extend beyond infection control.² Although advances such as direct-acting antivirals have transformed HCV treatment and expanded prevention efforts, gaps remain in identifying undiagnosed infections, ensuring timely treatment, and maintaining long-term liver disease monitoring.¹

In high-income countries, hepatitis prevention programs often focus on populations at increased risk, including people who inject drugs, individuals from hepatitis-endemic regions, and those facing socioeconomic barriers to care. This systematic review evaluated the effectiveness, cost-effectiveness, and implementation challenges of HBV/HCV prevention programs aimed at addressing chronic liver disease and HCC through screening, vaccination, antiviral treatment, and ongoing surveillance.

Researchers searched MEDLINE, Embase, CINAHL, and Scopus for studies published between January 2013 and November 2025 evaluating HBV and/or HCV prevention programs in high-income countries. Included studies assessed strategies such as population-based screening, targeted outreach, vaccination, antiviral treatment, liver monitoring, and HCC surveillance.

Early Treatment Associated With Lower HCC Risk and Reduced Costs

Across 23 studies, community-based screening initiatives targeting populations at elevated risk identified undiagnosed HBV/HCV infections in 15.3% to 34.3% of screened individuals. In addition, integrated care pathways and monitoring programs enabled detection of advanced fibrosis in 5.3% to 46.2% of participants and HCC in 3.5% to 39.2%.

Several successful programs used multidisciplinary models that combined primary care, specialty care, community organizations, and case management. These programs frequently incorporated point-of-care testing, noninvasive liver assessments, vaccination, antiviral therapy, and patient navigation services to improve linkage to care.

The review also 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 (adjusted sub-distribution HR [aSHR], 2.74; 95% CI, 1.78-4.22), whereas individuals who achieved sustained virologic response following HCV treatment experienced an 82% reduction in HCC risk (aSHR, 0.18; 95% CI, 0.12-0.27).

Modeling studies also demonstrated potential population-level benefits from expanded prevention strategies. 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. Expanded HBV/HCV screening, early antiviral treatment, vaccination, and HCC surveillance were generally considered cost-effective, with incremental cost-effectiveness ratios ranging from $1890 to $187,000 per quality-adjusted life-year gained.

Implementation Barriers Continue to Affect Hepatitis Prevention

Despite evidence supporting prevention strategies, several barriers limited 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 challenges to implementation.

Patient-level barriers also affected treatment initiation and long-term monitoring. The researchers noted that limited hepatitis awareness, stigma, socioeconomic instability, and difficulties maintaining follow-up contributed to gaps in care; across studies reporting these outcomes, loss to follow-up ranged from 11.5% to 39.6%.

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.

Integrated Care Models May Improve Long-Term Hepatitis Outcomes

Based on their review, the authors concluded that hepatitis prevention efforts must extend beyond identifying infections by incorporating comprehensive care models spanning diagnosis, treatment, and surveillance.

However, they acknowledged several limitations, including that most analyzed studies had limited follow-up periods and heterogeneous contexts and outcome measures, making long-term program effects unclear and reducing generalizability.

The researchers emphasized that additional longitudinal research is needed to determine whether large-scale implementation of hepatitis prevention programs directly reduces HCC incidence and mortality.

“…much of the evidence is constrained by small-scale implementation, inconsistent reporting, and limited examination of behavioural and structural determinants of participation and adherence,” they wrote. “Strengthening the implementation of patient-centered, integrated system-wide approaches is needed to support sustainable and equitable prevention efforts.”

References

1. Cai S, Dharmayani PNA, Lewandowska M, et al. Impacts of hepatitis B and C prevention programmes on long-term outcomes of advanced liver disease and hepatocellular carcinoma: a systematic review. Public Health. Published online July 3, 2026. doi:10.1016/j.puhe.2026.106384
2. Llovet JM, Kelley RK, Villanueva A, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7(1):6. doi:10.1038/s41572-020-00240-3