WHO 2030 HBV elimination goals: a goal too far?

In The Lancet Gastroenterology & Hepatology, the Polaris Observatory Collaborators report their latest iteration of the modelling of HBV prevalence, cascade of care, and prophylaxis. 1 Polaris Observatory CollaboratorsGlobal prevalence, cascade of care and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol. 2023; (published online July 27.)https://doi.org/10.1016/S2468-1253(23)00197-8 Google Scholar Some refinements have been made to the modelling, with better quality data, which have led to an estimated global burden of HBV infection of 257·5 million (95% uncertainty interval 216·6–316·4) in 2022—a reduction of around 34·5 million cases compared with the 292·0 million estimated for 2016. 2 Polaris Observatory CollaboratorsGlobal prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study. Lancet Gastroenterol Hepatol. 2018; 3: 383-403 Summary Full Text Full Text PDF PubMed Scopus (1123) Google Scholar By contrast, Cui and colleagues' recent study, 3 Cui F Blach S Manzengo Mingiedi C et al. Global reporting of progress towards elimination of hepatitis B and hepatitis C. Lancet Gastroenterol Hepatol. 2023; 8: 332-342 Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar which used WHO-collected data, estimated that 295·9 million (95% CI 228·2–422·6) people were living with chronic HBV infection in 2019. Both modelling studies produced large uncertainty intervals—ranges of 90 million and 194 million cases, respectively—raising the question of whether incremental changes in prevalence, prophylaxis, and outcomes are meaningful or credible. Modelling is only as good as the raw data on which it is based, which remains the weak point of such studies. Since five countries (China, India, Indonesia, Nigeria, and Ethiopia) were estimated to contribute 58% of the disease burden in 2022, 1 Polaris Observatory CollaboratorsGlobal prevalence, cascade of care and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol. 2023; (published online July 27.)https://doi.org/10.1016/S2468-1253(23)00197-8 Google Scholar the focus of validation should be on methods and strategies to improve good quality data in these countries. Each country is likely to have unique impediments and challenges with regard to data and validation that have not been elaborated, and whether these barriers can be overcome is an issue not just of political will, but also of leadership, infrastructure, and funding. The Polaris Observatory authors note that there are limitations to their data, such as a lack of recent data in some countries, differences between rural and urban areas, and effects of immigration. As more updated data become available, and resolution of such limitations are overcome, estimates of disease burden are likely to change, but certainty with regard to estimates can only be clearer when the confidence intervals narrow. The ten countries that drive most of the uncertainty include four of the five countries contributing 58% of the disease burden (the range of uncertainty being around 7 million in Nigeria, 6 million in China, 4 million in India, and 3 million in Indonesia); thus, strategies to improve data quality from these countries are necessary. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling studyAs 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks. Although prevention measures have had the most success, there is a need to increase these efforts and to increase diagnosis and treatment to work towards the elimination goals. Full-Text PDF