Characteristics and Screening Strategies of Hepatitis B in Guangdong Province, China

Determining the characteristics of hepatitis B virus (HBV) infection in the healthy population and evaluating the effectiveness of detection strategies will facilitate the optimization of hepatitis B screening strategies in the community and accelerate the elimination of HBV infection in China by the end of 2030. Hepatitis B surface antigen (HBsAg)-electrochemiluminescence immunoassays (ECLIAs), HBsAg-rapid diagnostic tests (RDTs), and HBV DNA-nucleic acid tests (NATs) were performed on serum samples from 2721 community-based healthy participants in Guangdong Province. The screening performance of the RDT and NAT and the distribution characteristics of HBsAg and HBV DNA were evaluated. The prevalence rates of HBsAg-ECLIA, HBsAg-RDT and HBV DNA-NAT in Guangdong Province were 6.10% (95% CI: 5.26~7.06), 4.96% (95% CI: 4.21~5.84) and 6.55% (95% CI: 5.64~7.49), respectively, and the prevalence rates for the three methods for individuals aged over 30 years were 11.18%, 10.92% and 12.57%, respectively. When the ECLIA was used as the gold standard, the sensitivities of the RDT, NAT and RDT and NAT in parallel were 80.7% (95% CI: 73.9~86.4), 86.7% (95% CI: 80.6~91.5) and 93.4% (95% CI: 88.5~96.6), respectively, and the sensitivity of the RDT and NAT in parallel was greater than that of the RDT alone (p < 0.001). The parallel RDT and NAT revealed an additional cost-benefit ratio (ACBR) < 1 for males and individuals aged over 30 years, which indicated that switching from the RDT screening strategy to the RDT and NAT in parallel is more cost effective. Adults aged over 30 years are the main population with hepatitis B infection in Guangdong Province, China, whose prevalence of HBsAg-ECLIA was 11.18%. Single RDT screening is prone to miss individuals with low levels of HBsAg. It is recommended to implement an RDT and NAT in parallel for individuals older than 30 years.