Background and context
Hepatitis B serology testing and hepatitis B virus (HBV) DNA testing is important to identify people living with chronic hepatitis B and to provide best quality healthcare. This document recommends testing pathways for hepatitis B. It provides a clear guide for testing that can be accessed by health professionals as well as links to further information for people with hepatitis B.
The prevalence of hepatitis B infection in Australia
HBV infection is a major global public health threat with over 250 million people living with chronic infection.1 In 2017, it was estimated that 221,420 people, or 1% of the population in Australia were living with HBV infection.2 Late diagnosis of hepatitis B is a missed opportunity for preventing liver cirrhosis, liver cancer and death from liver failure. Liver cancer is the fastest increasing cause of cancer death in Australia.3
The majority of hepatitis B infections in Australia are chronic (having persisted for more than 6 months duration) and occur in people born in countries of intermediate and high prevalence who contracted the infection at birth or during early childhood. Over 60% of people in Australia with hepatitis B are from two priority populations:
- adults and children from culturally and linguistically diverse (CALD) backgrounds, particularly people born in countries of intermediate and high HBV prevalence, including all indigenous peoples from overseas countries (see Priority populations for HBV testing)
- Aboriginal and Torres Strait Islander people.
Other priority populations for testing include anyone at risk of blood borne infection including people who are HIV positive, men who have sex with men, sex workers, people who inject drugs and people who have been incarcerated (see Indications for HBV testing).
In recognition of the global public health impact of hepatitis B, the World Health Organization (WHO) has set clear hepatitis B elimination targets of a 90% reduction in new infections and a 65% reduction in hepatitis B-related mortality WHO recommends achieving these targets with ambitious goals of diagnosing 90% persons living with hepatitis B, linking 80% to care and treating 80% of those eligible by 2030. The Third National Hepatitis B strategy sits within this global context and sets short-term targets of 80% of people living with hepatitis B diagnosed, 50% of those diagnosed linked to care, and 20% on treatment to achieve a 30% reduction in mortality by 2022.4
Australia has implemented prevention interventions including promotion of standard precautions; blood donor screening; vaccination programs for adolescents and universal birth dose and infant vaccination in 2000 and these strategies have reduced incidence among Australian-born children and adolescents. With ongoing high coverage of infant hepatitis B programs in many countries, the prevalence of chronic hepatitis B in migrants to Australia will fall in coming decades.2
The importance of hepatitis B testing
Hepatitis B testing is essential to ensure people living with hepatitis B infection are diagnosed, adequately informed and counselled, effectively linked to care and treatment in a timely manner to avoid adverse health outcomes and prevent ongoing transmission.6 It is vital to ensure people at risk of exposure are vaccinated to prevent transmission. Appropriate testing indicates whether an individual has:
- current hepatitis B infection (acute or chronic)
- cleared the virus spontaneously (natural immunity)
- immunity through previous hepatitis B vaccination.
Hepatitis B testing determines the severity and stage of infection, and these results direct decisions about whether antiviral therapy is indicated.5 Despite the public health and individual benefits of testing, it is estimated that around 30% of people with HBV infection in Australia remain undiagnosed.25