Among people receiving treatment The aim of monitoring people receiving treatment is to evaluate the effectiveness of treatment response, treatment adherence, adverse effects of treatment, progression of liver disease and development of HCC. HBV DNA testing is important for monitoring treatment response, even when HBV DNA measurement was not part of initial assessment for treatment eligibility. Very rarely it can indicate the potential for ending treatment. If antiviral therapy is discontinued, liver function should be monitored closely, since severe acute exacerbations of hepatitis have been reported, and antiviral therapy may need to be resumed. Among people who do not meet the criteria for antiviral therapy or want to defer therapy The aim of monitoring in people not on antiviral therapy is to identify an early change in clinical status (levels of HBV DNA or serum ALT or increasing APRI or transient elastography score) that indicates a risk of progressive liver disease and need for antiviral therapy, but before advanced hepatic fibrosis or cirrhosis develops. Monitoring of adherence and completeness of HBV DNA suppression requires periodically measuring HBV DNA levels. There are cost implications to regular ALT and HBV DNA monitoring for those receiving treatment or who do not yet meet criteria for treatment.

• The introduction of multi-disease testing platforms, both high-throughput laboratory-based and POC devices, represents an additional opportunity for integration that may further expand access and achieve significant system efficiency and cost savings.
• There is potential for adopting differentiated care models with primary or community care and nurse-led services for people with stable disease receiving treatment and specialist referral and care for people with advanced disease and cirrhosis.
• Additional training of health-care workers will be required for interpreting laboratory results and decision-making, especially when non-specialist physicians or nurses provide care and follow-up (see Chapter 15).