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Guideline

WHO guidelines on hepatitis B and C testing.

Year of Publication
2017
Issuing Institution
WHO
Links
Virtual Health Library,Pubmed,Google Scholar,WHO IRIS

Recommendations

25 included recommendations

WHO TO TEST FOR CHRONIC HBV INFECTION. In settings with a ≥2% or ≥5% HBsAg seroprevalence in the general population, it is recommended that all adults have routine access to and be offered HBsAg serological testing with linkage to prevention, care and treatment services. General population testing approaches should make use of existing community or health facility-based testing opportunities or programmes such as at antenatal clinics, HIV or TB clinics

Status
Maintained

Recommended in favor

Conditional

WHO TO TEST FOR CHRONIC HBV INFECTION. In all settings (and regardless of whether delivered through facility- or community based testing), it is recommended that HBsAg serological testing and linkage to care and treatment services be offered to the following individuals: • Adults and adolescents from populations most affected by HBV infection (i.e. who are either part of a population with high HBV seroprevalence or who have a history of exposure and/or high-risk behaviours for HBV infection); • Adults, adolescents and children with a clinical suspicion of chronic viral hepatitis (i.e. symptoms, signs, laboratory markers); • Sexual partners, children and other family members, and close household contacts of those with HBV infection; • Health-care workers: in all settings, it is recommended that HBsAg serological testing be offered and hepatitis B vaccination given to all health-care workers who have not been vaccinated previously (adapted from existing guidance on hepatitis B vaccination)

Status
Maintained

Recommended in favor

Strong

In all settings (and regardless of whether delivered through facility- or community based testing), it is recommended that serological testing for HCV antibody (anti- HCV) be offered with linkage to prevention, care and treatment services to the following individuals: • Adults and adolescents from populations most affected by HCV infection (i.e. who are either part of a population with high HCV seroprevalence or who have a history of exposure and/or high-risk behaviours for HCV infection); • Adults, adolescents and children with a clinical suspicion of chronic viral hepatitis (i.e. symptoms, signs, laboratory markers). Note: Periodic re-testing using HCV NAT should be considered for those with ongoing risk of acquisition or reinfection

Status
Maintained

Recommended in favor

Strong

In settings with a ≥2% or ≥5% HCV antibody seroprevalence in the general population, it is recommended that all adults have access to and be offered HCV serological testing with linkage to prevention, care and treatment services. General population testing approaches should make use of existing community- or facility-based testing opportunities or programmes such as HIV or TB clinics, drug treatment services and antenatal clinics

Status
New

Recommended in favor

Conditional

For the diagnosis of chronic HBV infection in adults, adolescents and children (>12 months of age), a serological assay (in either rapid diagnostic tests or laboratory-based immunoassay format) that meets minimum quality, safety and performance standards (with regard to both analytical and clinical sensitivity and specificity) is recommended to detect hepatitis B surface antigen (HBsAg). - In settings where existing laboratory testing is already available and accessible, laboratory-based immunoassays are recommended as the preferred assay format. - In settings where there is limited access to laboratory testing and/or in populations where access to rapid testing would facilitate linkage to care and treatment, use of rapid diagnostic tests (RDTs) is recommended to improve access.

Status
Maintained

Recommended in favor

Strong

HOW TO TEST FOR CHRONIC HBV INFECTION AND MONITOR TREATMENT RESPONSE. In settings or populations with an HBsAg seroprevalence of ≥0.4%, a single serological assay for detection of HBsAg is recommended, prior to further evaluation for HBV DNA and staging of liver disease. In settings or populations with a low HBsAg seroprevalence of <0.4%, confirmation of HBsAg positivity on the same immunoassay with a neutralization step or a second different rapid diagnostic test (RDT) assay for detection of HBsAg may be considered.

Status
Maintained

Recommended in favor

Conditional

Monitoring for HBV treatment response and disease progression. It is recommended that the following be monitored at least annually: - ALT levels (and AST for APRI), HBsAg, HBeAg, and HBV DNA levels (where HBV DNA testing is available) - Non-invasive tests (APRI score or transient elastography) to assess for presence of cirrhosis in those without cirrhosis at baseline; - If on treatment, adherence should be monitored regularly and at each visit.

Status
Maintained

Recommended in favor

Strong

Monitoring for HBV treatment response and disease progression. In persons on treatment or following treatment discontinuation: more frequent on treatment monitoring (at least every 3 months for the first year) is indicated in: persons with more advanced disease (compensated or decompensated cirrhosis); during the first year of treatment to assess treatment response and adherence; where treatment adherence is a concern; in HIV-coinfected persons; and in persons after discontinuation of treatment.

Status
Maintained

Recommended in favor

Conditional

HOW TO TEST FOR CHRONIC HCV INFECTION AND MONITOR TREATMENT RESPONSE. To test for serological evidence of past or present infection in adults, adolescents and children (>18 months of age), an HCV serological assay (antibody or antibody/antigen) using either rapid diagnostic test (RDT) or laboratory-based immunoassay formats that meet minimum safety, quality and performance standards (with regard to both analytical and clinical sensitivity and specificity) is recommended. - In settings where there is limited access to laboratory infrastructure and testing, and/or in populations where access to rapid testing would facilitate linkage to care and treatment, rapid diagnostic tests (RDTs) are recommended.

Status
New

Recommended in favor

Strong