One Third of Chronic Hepatitis B Patients Are Lost to Follow-Up

A retrospective service-improvement review from a UK hepatology program found that one third of adults with chronic hepatitis B virus (HBV) infection were no longer engaged in specialist care, a gap that could hinder progress toward the World Health Organization’s 2030 viral-hepatitis elimination goals.¹

Among 1,539 HBsAg-positive patients diagnosed between June 2007 and December 2021, 32.9% (506) had no hepatology clinic visit after December 31, 2021; at last contact, >12% were HBeAg positive and 23.2% had elevated ALT, indicating risk for progression. Of 145 people still in catchment, 60 were reached by phone and 50 returned to clinic, re-engaging 10.07% (51/506) of the LTFU cohort. The leading reason for disengagement was high population mobility, with additional contributors including non-referral, administrative errors, and communication barriers spanning 65 languages among 474 individuals.¹

Investigators performed a retrospective case-finding and outreach exercise to identify HBsAg-positive adults who were lost to follow-up (LTFU), excluding acute infections. Records from 2007–2021 were reviewed, and individuals still residing locally were contacted by telephone to facilitate return to care.¹

Clinicians and programs can respond now by auditing registries to validate active status and flag overdue monitoring for HBsAg-positive patients, standardizing recall workflows that pair automated reminders with multilingual outreach and primary-care prompts, especially in high-mobility areas, and prioritizing higher-risk individuals (HBeAg positive or elevated ALT at last contact) for re-engagement; and tracking outcomes such as re-engagement rates and time to first follow-up to evaluate and refine recall strategies.¹

Limitations include that findings reflect a single center and rely on historical records; some patients may have transferred care elsewhere without documentation. Telephone outreach also limits reach in highly mobile populations.¹

In a past interview, Anu Osinusi, MD, MPH, vice president of clinical research at Gilead Sciences summarizes trial data on 2 HBV vaccines the company is developing.

Context From Recent Surveillance

Chronic HBV requires lifelong monitoring to determine treatment eligibility and prevent liver disease progression. This single-center experience suggests health systems may overestimate care coverage for HBV and miss opportunities for earlier intervention when patients disengage.¹

The UK signal aligns with national surveillance. UKHSA’s Hepatitis B in England 2024 estimates ~270,000 people living with HBV in 2022 (~0.6% overall; ~1.5% in London) and documents persistent gaps in diagnosis, treatment initiation, and retention, even as England maintains elimination of mother-to-child transmission through high antenatal screening and infant vaccine coverage. Early results from ED opt-out bloodborne virus testing identified 646 new HBV diagnoses in year one, highlighting scalable routes to find people currently outside specialist pathways. The report calls for expanded testing, stronger digital pathway tracking (including a planned HBV dashboard), and targeted equity efforts—measures that mirror the re-engagement needs surfaced in the study.²

At the global level, viral hepatitis caused an estimated 1.3 million deaths in 2022, with HBV accounting for 83%. Despite available tools, only about 13% of people with chronic HBV are diagnosed and ~3% receive antiviral therapy. WHO urges expanded testing, simplified service delivery, stronger primary-care prevention, and better data systems to reach 2030 goals.³ A 2025 WHO information sheet reiterates these gaps, estimating ~304 million people living with chronic HBV or HCV in 2022, persistent shortfalls in diagnosis and treatment (HBV 13% diagnosed/3% treated; HCV 36%/20%), suboptimal global HBV birth-dose coverage (43%; 17% in Africa), uneven service integration, and pricing barriers, underscoring the need to improve diagnosis, linkage, and retention to bend mortality.⁴

Across settings, a substantial share of people with chronic HBV are off pathway, and only a minority can be re-engaged without systematic processes. Registry audits, multilingual communication, standardized recall, and care-cascade tracking are immediate levers to close follow-up gaps and advance HBV elimination targets.

References

1.Jackson R, Marks A, Irving WL, Jack K. Identifying people with chronic hepatitis B virus who are lost to clinical follow up: A retrospective case finding and re-engagement service improvement exercise. Accessed October 13, 2025. J Clin Virol. 2025;105876. doi:10.1016/j.jcv.2025.105876

2.UKHSA. Hepatitis B in England 2024. Updated July 30, 2025. Accessed October 13, 2025.https://www.gov.uk/government/publications/hepatitis-b-in-england/hepatitis-b-in-england-2024

3.WHO. WHO sounds alarm on viral hepatitis infections claiming 3500 lives each day. April 9, 2024. Accessed October 13, 2025. https://www.who.int/news/item/09-04-2024-who-sounds-alarm-on-viral-hepatitis-infections-claiming-3500-lives-each-day

4.WHO. Viral hepatitis B and C burden of disease, WHO policy adoption status in countries, 2025. July 22, 2025. Accessed Pctober 13, 2025. https://cdn.who.int/media/docs/default-source/hq-hiv-hepatitis-and-stis-library/2025-whd-hep-information-sheet.pdf