World: Prevention, Diagnosis and Management of Hepatitis B: Operational Toolkit for Healthcare Workers Across All Levels of Care

Country: World Source: Africa Centres for Disease Control and Prevention Please refer to the attached files. EXECUTIVE SUMMARY Globally, an estimated 240 million people are living with chronic hepatitis B (PLWHB). The WHO Africa region is disproportionately affected, accounting for 68% of new hepatitis B virus (HBV) infections but having the lowest coverage of timely hepatitis B birth-dose (HepB-BD) vaccination (17%). Of the 64 million PLWHB in Africa, only 6% (3. 9 million) had been diagnosed, and just 1. 6% (1 million) had received treatment by 2024, despite the availability of accurate WHO prequalified diagnostics and effective, low-cost antiviral therapy. Hepatitis B caused an estimated 308, 000 deaths in Africa in 2024. We need to urgently scale up prevention, diagnosis and treatment to prevent new infections and liver-related deaths. In 2024, the WHO African region recorded 612 000 new HBV infections and together with the Western Pacific region accounted for three quarters of the global 1. 1 million HBV related deaths. Chronic hepatitis B is a silent disease and is typically asymptomatic until complications such as cirrhosis and hepatocellular carcinoma (HCC) develop. It is essential to improve diagnosis, linkage to care, treatment uptake and long term follow up for PLWHB. The operational toolkit should be used alongside the WHO 2024 Hepatitis B Guidelines, the WHO HBV Policy Brief, and the WHO Consolidated Guidance on Hepatitis B and C prevention, testing, treatment, service delivery and monitoring: an implementation handbook for a public health approach. This Africa CDC HBV operational toolkit is based on the WHO 2024 Hepatitis B Guidelines. [2] The toolkit provides practical, easy-to-use management algorithms for healthcare workers across all levels of the health system in Africa, including for those practicing at community, primary care and rural settings. Companion Mobile App This toolkit is accompanied by an App available on the App store for iOS (Apple devices) and the Google Play store for Android devices. The app provides all the materials included in this toolkit and has an interactive treatment advisor to help clinicians determine if treatment is recommended. It includes a calculator for the APRI score and creatinine clearance, and recommendations on doses for renal impairment. Search for “Africa CDC Hepatitis B toolkit” in the App Store or Google Play on your device to download it. In this toolkit, management and referral pathway algorithms are adapted to different levels of care, reflecting the available resources at each level and enabling HBV treatment and care at all levels. Healthcare systems in Africa are stratified into 5 levels based on the resources available for HBV prevention, diagnosis, treatment and monitoring. Each level offers progressively more advanced and comprehensive diagnostic and therapeutic capabilities. Levels of care: Level 0: Community and Outreach Focuses on awareness, basic screening, and referral. Often facilitated by community health workers and outreach programmes. Level 1: Primary Care Provides essential health services including initial screening, basic laboratory tests, and vaccination. Level 2: District Hospital Equipped for basic diagnostics, limited imaging, and some specialised services. Level 3: Regional Hospital Offers more advanced diagnostics and imaging, and specialist services. Level 4: Tertiary Level Hospital/Academic Centres Provides comprehensive diagnostics, advanced imaging, specialised care, research and training.

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