Current policies and practices for testing and treatment of chronic hepatitis B and C infection in high-burden countries in the WHO European region

Abstract Chronic hepatitis B and hepatitis C remain major public health concerns in the WHO European Region, where an estimated 10.6 million people were living with HBV infection and 7.7 million with HCV infection in 2022. Despite this substantial burden, diagnosis and treatment coverage remain low, posing a significant challenge to achieving the WHO regional goal of viral hepatitis elimination by 2030. To assess country-level progress and gaps in hepatitis testing and treatment, the WHO Regional Office for Europe conducted a survey among nine high burden countries, receiving responses from eight: Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Turkmenistan and Uzbekistan. The survey examined national policies, testing availability, treatment regimens, service delivery approaches, and key implementation barriers. Most countries reported having national HBV and HCV guidelines aligned with international standards, although planned updates were inconsistent. Point of care PCR viral load testing was available in five countries, but coverage of test costs varied, and reflex PCR testing had been implemented in only four. First line antiviral regimens largely followed international guidance; however, medication prices and national coverage differed considerably, with out of pocket payment requirements persisting in several settings. All countries reported the use of non invasive tests for liver disease staging, though coverage for elastography remains limited. Service delivery has become increasingly decentralized, with HBV and HCV testing and care available across multiple levels of the health system and integrated into primary care and HIV clinics in most countries. Nevertheless, provision of HCV treatment in harm reduction settings remains rare, limiting access for populations at highest risk. Overall, the findings indicate strong political commitment but highlight persistent gaps in testing access, treatment affordability, and service delivery models. Addressing these gaps through tailored country specific strategies, expanded financial protection, and strengthened integration of services will be essential to accelerate progress toward the 2030 elimination targets.