Beyond HIV prevention: Reframing PrEP clinics as hubs for viral hepatitis prevention and elimination

Abstract Objectives The expansion of HIV pre‐exposure prophylaxis (PrEP) has created a growing network of prevention services that regularly engage people who may also be exposed or susceptible to viral hepatitis. PrEP care is inherently longitudinal, involving repeated clinical assessment, laboratory testing, counselling and vaccination review. These features make PrEP clinics uniquely positioned to contribute to viral hepatitis prevention and elimination. In this narrative review, we synthesize evidence on the integration of viral hepatitis prevention, screening, diagnosis and care within PrEP services, and propose a practical framework, the PrEP–viral hepatitis elimination cascade, for translating the principle of integrated HIV, viral hepatitis and sexually transmitted infection services into routine clinical practice. Methods A focused literature search was conducted between 1 May and 8 August 2026 across PubMed/MEDLINE, Embase, Scopus and the WHO Global Index Medicus, using documented search strings supplemented by hand‐searching of reference lists. We prioritized studies conducted among PrEP users or within PrEP programmes, together with relevant international guidelines and policy documents. Records were screened in two stages against predefined eligibility criteria, and the findings were mapped to the steps of the cascade. Evidence was sought on HAV and HBV vaccination coverage, HBV seroprevalence and susceptibility, the relationship between tenofovir‐based PrEP and HBV prevention, HCV epidemiology among PrEP users, simplified diagnostic strategies and integrated service delivery models. Given the heterogeneity of study designs and outcomes, the literature was synthesized narratively rather than through formal meta‐analysis. Interventions and indicators for each cascade step were then summarized in an evidence‐linked implementation and monitoring table. Results The evidence consistently demonstrates that vaccination gaps for HAV and HBV persist among PrEP users, with suboptimal initiation and completion rates across settings; that HBV susceptibility remains common among individuals entering PrEP care; and that tenofovir‐based PrEP, while offering incidental HBV protection, should not substitute for vaccination. HCV epidemiology among PrEP users is heterogeneous, supporting risk‐adapted testing strategies, while simplified diagnostic pathways and self‐testing approaches have shown promise for HCV. The PrEP–viral hepatitis elimination cascade proposed here offers a structured, implementable framework connecting vaccination, case finding, linkage to care and longitudinal reassessment within the existing PrEP pathway. The cascade is presented as a detailed figure and as an implementation and monitoring table linking each step to supporting evidence, candidate interventions and measurable indicators, without assigning responsibilities to specific providers. Implementation challenges include variability in PrEP delivery models, the need for equity‐oriented approaches and the implications of long‐acting and tenofovir‐sparing PrEP regimens for HBV prevention. Conclusion PrEP programmes have created a longitudinal prevention infrastructure that extends beyond HIV prevention. HAV vaccination, HBV screening and vaccination, identification of chronic HBV infection, HCV testing, simplified diagnostics, treatment linkage and surveillance for reinfection can all be incorporated at different points of the PrEP pathway. The next step is to move from opportunistic to intentional integration. PrEP clinics should be reframed as integrated viral hepatitis prevention and elimination hubs, translating global strategies into routine care and contributing to viral hepatitis elimination goals. The question is no longer whether PrEP clinics can contribute to viral hepatitis elimination, but whether the global health community will deliberately invest in making this integration a reality.