Hepatitis B Re-Engagement Hinges on How Systems Find Patients: Helen Nde, MPH

Why It Matters

Effective re‑engagement directly influences treatment uptake, a critical lever for achieving global hepatitis B elimination goals, especially in regions bearing the heaviest disease burden.

Key Takeaways

• Active, in‑person outreach yields highest hepatitis B re‑engagement rates.
• Passive, ED‑based screening achieved 100% re‑engagement in small samples.
• Dutch GP‑mediated approach limited to 2% due to legal friction.
• 10 of 11 studies from high‑income nations, LMIC evidence scarce.
• Tenofovir is cheap, effective, yet chronic HBV patients remain untreated.

Pulse Analysis

Re‑engagement is emerging as a linchpin in the fight against chronic hepatitis B. The recent scoping review underscores how the method of patient contact reshapes outcomes: proactive outreach—phone calls, text messages, and especially face‑to‑face interactions by trusted community navigators—drives linkage to care far more effectively than indirect, passive approaches. In high‑income settings, programs that intercept patients in emergency departments or primary‑care visits have reported re‑engagement rates up to 100%, albeit in limited cohorts, while systems that rely on intermediary physicians, as seen in the Netherlands, struggle to surpass a 2% success rate. These findings illuminate a clear operational lesson: the closer the health system gets to the patient, the higher the likelihood of re‑engagement.

The review also exposes a critical blind spot: the overwhelming majority of published data originates from wealthy nations, even though the global hepatitis B burden is concentrated in low‑ and middle‑income countries (LMICs). In many endemic regions, re‑engagement activities such as phone‑based follow‑up or community‑driven outreach are happening on the ground but remain undocumented in peer‑reviewed literature. This evidence gap hampers the ability of policymakers and funders to benchmark progress, allocate resources efficiently, and replicate successful models where they are needed most. Moreover, the focus in LMICs often skews toward vaccination and maternal‑screening programs, leaving a sizable cohort of chronically infected adults without systematic pathways back into care.

Achieving the World Health Organization’s target of a 65% reduction in hepatitis B‑related mortality will require coordinated policy shifts. Governments must invest in scalable outreach infrastructures—leveraging digital case‑finding tools, community health workers, and integrated electronic alerts—to bridge patients back to treatment. At the same time, reducing stigma through culturally tailored education and ensuring affordable access to tenofovir, a low‑cost antiviral, are essential. By documenting and disseminating successful re‑engagement strategies across diverse health systems, the global community can accelerate progress toward elimination and safeguard millions from preventable liver disease.