Blueprint to hepatitis B elimination in China: A modelling analysis of clinical strategies
Rui Li,
Mingwang Shen,
Jason J. Ong,
Fuqiang Cui,
Wenyi Hu,
Polin Chan,
Zhuoru Zou,
Shu Su,
Hangting Liu,
Lei Zhang,
Wai-Kay Seto,
William C.W. Wong
Affiliations
Rui Li
China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China; Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia; Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
Mingwang Shen
China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China
Jason J. Ong
China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China; Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia; Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
Fuqiang Cui
School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
Wenyi Hu
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia; Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, VIC, Australia
Polin Chan
Communicable Diseases Team, WHO India Country Office, New Delhi, India
Zhuoru Zou
China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China
Shu Su
China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China; Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia; Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China; School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia; Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, VIC, Australia; Communicable Diseases Team, WHO India Country Office, New Delhi, India; Department of Epidemiology and Biostatistics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Medicine, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China; Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong; Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
Hangting Liu
China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China
Lei Zhang
China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an, China; Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia; Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Corresponding authors. Addresses: Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong (W.C.W. Wong); Department of Medicine, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China (W-K. Seto); China–Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China (L. Zhang).
Wai-Kay Seto
Department of Medicine, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China; Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong; Corresponding authors. Addresses: Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong (W.C.W. Wong); Department of Medicine, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China (W-K. Seto); China–Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China (L. Zhang).
William C.W. Wong
Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Corresponding authors. Addresses: Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong (W.C.W. Wong); Department of Medicine, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China (W-K. Seto); China–Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China (L. Zhang).
Background & Aims: Globally, one-third of individuals infected with HBV live in China. Eliminating HBV in China would therefore be paramount in achieving the World Health Organization’s (WHO’s) targets of viral hepatitis elimination as a worldwide public health threat. Methods: We constructed a dynamic HBV transmission model in China, structured by age and sex. We calibrated the model by HBsAg prevalence, acute HBV incidence, and nationally reported HBV-related cancer mortality. We investigated seven intervention scenarios (A–G) based on assumptions in diagnostic, linkage-to-care, and treatment coverages in achieving the WHO’s HBV elimination goals. Results: With the status quo, HBsAg prevalence among children 1–4 years would reduce to 0.09% (95% CI 0.09–0.10%) by 2025; acute HBV incidence would drop to <2/100,000 person-years by 2024, achieving the elimination target of 90% incidence reduction. Nonetheless, China would not achieve a 65% reduction target in HBV-related mortality until 2059 with 9.98 (95% CI 9.27–10.70) million HBV-related deaths occurred by 2100. If China achieves 90% diagnostic and 80% treatment coverages (scenario E), HBV elimination would be achieved 8 years earlier, potentially saving 1.98 (95% CI 1.83–2.12) million lives. With more effective therapies for HBV control in preventing cirrhosis and hepatocellular carcinoma, elimination targets could be achieved in 2048 (scenario F) and 2038 (scenario G), additionally saving 3.59 (95% CI 3.37–3.82) and 5.19 (95% CI 4.83–5.55) million lives, respectively. Conclusions: Eliminating HBV will require interventional strategies to improve diagnostic, linkage-to-care, and treatment coverages. Developing novel therapies will be crucial in further reducing HBV-related mortality and removing HBV as a public health threat. Impact and Implications: This study explores the key developments and optimal intervention strategies needed to achieve WHO hepatitis B elimination targets by 2030 in China. It highlights that China can realise the HBV elimination targets in the incidence by 2025, and by upscaling diagnostic, linkage-to-care, and treatment coverages, up to 2 million lives could potentially be saved from HBV-related deaths.
