The hepatitis B care cascade among key populations towards global elimination: a systematic review and meta-analysis

Key populations bear a disproportionate burden of hepatitis B virus (HBV). We synthesized evidence on the HBV care cascade among key populations to inform strategies toward WHO's 2030 elimination targets.

We conducted a systematic review and meta-analysis of observational studies published during 2019.01.01-2025.10.31, identified from PubMed, Web of Science, Ovid, and Embase. Eligible studies reported HBV care cascade indicators (vaccination, screening, linkage to care, treatment, adherence, positivity, virological suppression and functional cure) among people living with HIV (PLHIV), men who have sex with men (MSM), female sex workers (FSW), drug users (DU), and detainees across WHO regions. Meta-analysis (PROSPERO CRD42024569607) was performed using generalized linear mixed models. Heterogeneity was assessed with I ².

We included 693 data points from 329 studies. Cascade varied substantially among key populations. PLHIV were the only group with full-cascade estimates, showing vaccination at 16.3% (95% CI, 11.4-22.8), screening 68.8% (53.4-80.9), linkage to care 88.1% (49.5-98.3), treatment 88.9% (84.3-92.3), adherence 86.1% (71.1-93.9), HBV positivity 7.6% (6.8-8.6), virological suppression 75.7% (66.3-83.1) and functional cure 8.4% (6.0-11.5). Data for other key populations were sparse. MSM had the highest vaccination (48.0%, 42.1-53.9), but the lowest screening uptake (59.9%, 47.9-70.8). FSW had the lowest vaccination (10.3%, 3.7-25.8) and relatively high positivity (7.1%, 4.9-10.3). DU achieved the highest functional cure (15.4%, 10.1-23.0). Detainees had low vaccination (25.6%, 13.1-44.2) and low HBV positivity (2.6%, 1.8-3.7). Regional variation was significant (all p < 0.05): the Western Pacific had higher HBV positivity but stronger treatment adherence and virological suppression, whereas Africa showed the lowest vaccination, screening, and treatment coverage despite the highest burden.

HBV care cascade data remain inadequate for key populations. Vaccination and screening are suboptimal in all populations, although PLHIV show strong treatment coverage and adherence.

This work was supported by the National Key R&D Program of China (2022YFC2304900, 2022YFC2505100), The National Natural Science Foundation of China (81950410639, 82304246); Outstanding Young Scholars Support Program (3111500001); Xi'an Jiaotong University Basic Research and Profession Grant (xtr022019003, xzy032020032) and Xi'an Jiaotong University Young Scholar Support Grant (YX6J004); the Bill & Melinda Gates Foundation (20200344); Kuanren Talent programmes of the second affiliated hospital of Chongqing Medical University (202417-16). Shaanxi Province "Three Qin Scholars" Innovation Team Project (2023001), the Fundamental Research Funds for the Central Universities (xtr062023003) and the Health and Wellness Scientific Research and Innovation Project of Shaanxi Province (2025TD-09).