Seroprevalence of hepatitis B and hepatitis C and its trends in India: a systematic review and meta-analysis

Hepatitis B (HBV) and Hepatitis C (HCV) are major public health challenges in India. Yet, the existing prevalence studies differ significantly regarding population characteristics, geographic location, and study design, complicating the interpretation of the overall disease burden. This systematic review and meta-analysis aimed to synthesize HBV and HCV seroprevalence in India from available evidence and identify variations across key subpopulations. A systematic search was conducted on PubMed, Embase, and Scopus for studies published from January 1999 to September 2024 reporting HBV and/or HCV seroprevalence in India. Following PRISMA guidelines, 87 studies (61 on HBV, 69 on HCV) were included. Given substantial heterogeneity across studies, pooled seroprevalence was estimated using a random-effects model. Subgroup analyses were conducted by publication year, study setting, population, and geographical region to explore variability. Eighty-seven studies reporting HBV or HCV seroprevalence in India were included. Considerable heterogeneity was observed across studies ( I 2 > 99%), reflecting differences in study populations, geographic regions, and study settings. The pooled seroprevalence was 3.0% [95% CI 2.0–4.0%] for HBV (HBsAg + ) ( n = 693,879 participants) and 4.0% [95% CI: 2.0–7.0%] for anti-HCV antibody ( n = 1,079,706 participants). However, substantial variation was observed across study populations. HBV prevalence ranged from approximately 1.0% among blood donors to higher levels in community-based settings (7.0%) and high-risk populations (4.0%). Geographically, HBV prevalence was highest in Northern (3.0%) and Western (3.0%) India. For HCV, prevalence was markedly higher among high-risk populations (11.0%). Regional analysis showed the highest HCV seroprevalence in Eastern India (10.0%) and Northern India (6.0%). Molecular confirmatory tests such as reverse transcription polymerase chain reaction (RT-PCR), HBV DNA, or HCV RNA detection were reported in 19 of the 87 included studies (21.8%); chemiluminescent microparticle immunoassay (CMIA) was classified as a serological immunoassay rather than a molecular method. These findings indicate considerable heterogeneity in the epidemiology of viral hepatitis across populations in India. This study highlights the persistent burden of HBV and HCV in India. Scaling up community-based screening, decentralizing molecular testing, and improving linkage-to-care are essential to strengthen India’s National Viral Hepatitis Control Programme (NVHCP) and to achieve the WHO 2030 Viral Hepatitis elimination targets. Systematic review registration: PROSPERO CRD42024576147