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Table 2 Adaptation (with permission) of Table 1. Summary of recommendations on testing for chronic hepatitis B and C virus infection, from WHO Guidelines on hepatitis B and C testing [10]). Who to test for chronic HBV infection

From: WHO guidelines on testing for hepatitis B and C – meeting targets for testing

WHO TO TEST FOR CHRONIC HBV INFECTION
Testing approach and population Recommendationsa
General population testing 1. In settings with a ≥ 2% or ≥5%b HBsAg seroprevalence in the general population, it is recommended that all adults have routine access to and be offered HBsAg serological testing with linkage to prevention, care and treatment services.
 General population testing approaches should make use of existing community- or health facility-based testing opportunities or programmes such as at antenatal clinics, HIV or TB clinics.
Conditional recommendation, low quality of evidence
Routine testing in pregnant women 2. In settings with a ≥ 2% or ≥5%%b HBsAg seroprevalence in the general population, it is recommended that HBsAg serological testing be routinely offered to all pregnant women in antenatal clinicsc, with linkage to prevention, care and treatment services. Couples and partners in antenatal care settings should be offered HBV testing services.
Strong recommendation, low quality of evidence
Focused testing in most affected populations 3. In all settings (and regardless of whether delivered through facility- or community- based testing), it is recommended that HBsAg serological testing and linkage to care and treatment services be offered to the following individuals:
 • Adults and adolescents from populations most affected by HBV infectiond (i.e. who are either part of a population with high HBV seroprevalence or who have a history of exposure and/or high-risk behaviours for HBV infection);
 • Adults, adolescents and children with a clinical suspicion of chronic viral hepatitise (i.e. symptoms, signs, laboratory markers);
 • Sexual partners, children and other family members, and close household contacts of those with HBV infectionf;
 • Health-care workers: in all settings, it is recommended that HBsAg serological testing be offered and hepatitis B vaccination given to all health-care workers who have not been vaccinated previously (adapted from existing guidance on hepatitis B vaccination g)
Strong recommendation, low quality of evidence
Blood donors Adapted from existing 2010 WHO guidance (Screening donated blood for transfusion transmissible infections h ) 4. In all settings, screening of blood donors should be mandatory with linkage to care, counselling and treatment for those who test positive.
  1. Abbreviations: HBsAg hepatitis B surface antigen, PWID people who inject drugs, MSM men who have sex with men
  2. aThe GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) was used to categorize the strength of recommendations as strong or conditional (based on consideration of the quality of evidence, balance of benefits and harms, acceptability, resource use and programmatic feasibility) and the quality of evidence as high, moderate, low or very low
  3. bA threshold of ≥2% or ≥5% seroprevalence was based on several published thresholds of intermediate or high seroprevalence. The threshold used will depend on other country considerations and epidemiological context
  4. cMany countries have chosen to adopt routine testing in all pregnant women, regardless of seroprevalence in the general population, and particularly where seroprevalence ≥2%. A full vaccination schedule including birth dose should be completed in all infants, in accordance with the WHO position paper on hepatitis B vaccines 2009g
  5. dIncludes those who are either part of a population with higher seroprevalence (e.g. some mobile/migrant populations from high/intermediate endemic countries, and certain indigenous populations) or who have a history of exposure or high-risk behaviours for HBV infection (e.g. PWID, people in prisons and other closed settings, MSM and sex workers, HIV-infected persons, partners, family members and children of HBV-infected persons)
  6. eFeatures that may indicate underlying chronic HBV infection include clinical evidence of existing liver disease, such as cirrhosis or hepatocellular carcinoma (HCC), or where there is unexplained liver disease, including abnormal liver function tests or liver ultrasound
  7. fIn all settings, it is recommended that HBsAg serological testing with hepatitis B vaccination of those who are HBsAg negative and not previously vaccinated be offered to all children with parents or siblings diagnosed with HBV infection or with clinical suspicion of hepatitis, through community- or facility-based testing
  8. gWHO position paper. Hepatitis B vaccines. Weekly Epidemiological Record. 2009;4 (84):405–20
  9. hScreening donated blood for transfusion transmissible infections. Geneva: World Health Organization; 2010