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Barriers to HBV Care
Overcoming Barriers to HBV Care in Key Communities 

Released: January 22, 2025

Expiration: January 21, 2026

Patricia D. Jones
Patricia D. Jones, MD, MSCR
Activity Information

Activity

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Key Takeaways
  • Healthcare professionals should adopt the CDC’s universal HBV screening and WHO’s simplified HBV treatment recommendations in their practice.
  • Community-based screening and management is crucial to raise HBV awareness, destigmatize HBV, and provide an opportunity for people to get screened and linked to care.

Hepatitis B virus (HBV) infection remains a health problem worldwide, with continued barriers to HBV care, especially among immigrant communities. For healthcare professionals (HCPs), barriers to HBV screening include knowing whom to screen for HBV and determining treatment eligibility. For patients, unreliable access to care, cost, and stigma are common barriers. In my practice, I mostly serve Caribbean-based communities and, unfortunately, I still encounter patients who are only diagnosed with HBV when they are being diagnosed with hepatocellular carcinoma. In this commentary, I address strategies to overcome these key barriers.

Universal Screening
The updated recommendations by the Centers for Disease Control and Prevention for universal HBV screening represent a major advancement in overcoming screening barriers and have helped reduce worry about insurance coverage for screening. Before, HCPs were mainly screening based on risk factors. This means that HCPs had to ask sensitive questions about personal behaviors, or they needed to know which patients were born in countries that had either intermediate or high endemicity for HBV. With the new recommendations, HCPs can simply look to see whether a patient has ever been screened for HBV. 

However, we still need to disseminate this information to HCPs to adopt universal screening in their practices and educate them about populations who are at increased risk for HBV and who will require repeat screening.

Simplified Treatment
Luckily, treatment for HBV has become simplified based on the updated World Health Organization HBV guidelines. Previously, determining treatment eligibility was challenging, even for specialists. Now HCPs do not need to consider whether the patient is hepatitis B e antigen positive or negative. HBV DNA level thresholds to consider for treatment eligibility have also simplified. Simplified screening and treatment recommendations are summarized here.

Community-based Screening and Management
To implement simplified screening and treatment recommendations, people need to be engaged in care. Unfortunately, the concept of primary care can differ between communities, especially among those not born in countries where primary care is common. In the United States, an emphasis is placed on preventive care and the concept that everyone should have a primary care provider. But people who have immigrated to the United States may not be aware of this standard.

In other countries, patients often visit a doctor only if they are symptomatic or go to the hospital only if they get sick. This may explain why some patients have not been screened for HBV. In addition, many are not able to afford health insurance or don’t understand the importance of it if they have no symptoms. These factors can all contribute to the additional concerns of not being able to access care or afford treatment.

Therefore, it is very important to think about how we deliver care to our patients. Use of community-based events can raise HBV awareness and provide an opportunity for people to get screened and linked to care. 

Destigmatizing HBV
HBV-related stigma is another major barrier. Where I practice, certain communities are blamed for HBV transmission, similar to what was observed when the HIV epidemic began. In addition, some patients are reluctant to receive HBV treatment because some medicines used to treat HBV infections are also used to treat HIV.

As a health system or an engaged individual, the goal should be to make people aware of the risks of HBV infection and how it is transmitted, and we must make all efforts to destigmatize the disease. Campaigns as part of community-based events can also help to overcome HBV-related stigma.

We also need to acknowledge potential patient mistrust rooted in past experiences and work to repair those relationships with our patients.

We have a lot to learn to improve HBV screening and reduce HBV-related stigma within our communities, and I believe the only way we can do this is through community-based work.

Your Thoughts?
In your practice, how have you overcome barriers to HBV care? Get involved in the discussion by posting a comment below.