Blueprint to hepatitis B elimination in China: A modelling analysis of clinical strategies

Abstract

<h3>Background & Aims</h3><p>Globally one-third of individuals infected with hepatitis B virus (HBV) live in China. Eliminating HBV in China would therefore be paramount in achieving the World Health Organization (WHO)’s targets of viral hepatitis elimination as a worldwide public health threat.</p><h3>Methods</h3><p>We constructed a dynamic HBV transmission model in China, structured by age and gender. We calibrated the model by hepatitis B surface antigen (HBsAg) prevalence, acute HBV incidence and nationally-reported HBV-related cancer mortality. We investigated seven intervention scenarios (A-G) based on assumptions in diagnostic, linkage-to-care and treatment coverages in achieving WHO’s HBV elimination goals.</p><h3>Results</h3><p>With <em>status quo</em>, HBsAg prevalence among children 1-4 years would reduce to 0.09% (95%CI: 0.09-0.10%) by 2025; acute HBV incidence would drop to <2/100,000 person-years by 2024, achieving the elimination target of 90% incidence reduction. Nonetheless, China would not achieve a 65% reduction target in HBV-related mortality until 2059 with 9.98 (9.27-10.70) million HBV-related deaths occurred by 2100. If China achieves 90% diagnostic and 80% treatment coverage (Scenario E), HBV elimination would be achieved eight years earlier potentially saving 1.98 (1.83-2.12) million lives. With more effective therapies for HBV control in preventing cirrhosis and HCC, elimination targets could be achieved in 2048 (Scenario F) and 2038 (Scenario G), additionally saving 3.59 (3.37-3.82) and 5.19 (4.83-5.55) million lives, respectively.</p><h3>Conclusions</h3><p>Eliminating HBV will require interventional strategies to improve diagnostic, linkage-to-care and treatment coverage. Developing novel therapies will be crucial in further reducing HBV-related mortality and removing HBV as a public health threat.</p>