In 2024, the WHO updated its guidelines for the prevention, diagnosis, treatment, and care of individuals infected with chronic hepatitis B [5]. The updated guidelines simplify clinical algorithms for the diagnosis, treatment, and monitoring of hepatitis B, expand treatment eligibility criteria, and provide alternative treatment options. The updated guidelines recommend four treatment eligibility options that will cover a higher proportion (at least 50%) of all HBsAg positive populations, thus providing more opportunities for chronic HBV-infected individuals to receive treatment. China’s 2022 version of the updated chronic hepatitis B prevention and treatment guidelines [6] pointed out that patients over 30 years of age with chronic HBV infection should be treated as long as HBV DNA is positive. Compared with the previous version of the guidelines [7], the restrictions on ALT values were removed, expanding the coverage of treatment for patients with chronic HBV infection. Considering the price of antiviral therapy with nucleoside drugs in China, this measure is also cost-effective [8]. Wong et al. analyzed 89,259 cases of chronic HBV infection with two HBV test results in a laboratory database in the United States. According to the criteria of the American Association for the Study of Liver Disease, European Association for Study of the Liver, Asian Pacific Association for Study of the Liver, and Asian American Treatment Algorithm, the proportions of chronic HBV-infected individuals meeting the treatment criteria were 6.7, 6.2, 5.8, and 16.4%, respectively [9]. But if ALT indicators are removed, the treatment coverage will reach around 87%. However, this strategy should also consider patients’ actual receipt of treatment and their adherence to medication. Therefore, it is also important to focus on doctors’ popularization of patient related knowledge and community education.

Hepatitis B also requires special attention to the African region, where 63% of new hepatitis B infections worldwide occurred, and the diagnosis and treatment coverage of hepatitis B is still below 5%. The same situation also exists in Southeast Asia. In the African region, the diagnosis rate of hepatitis C is still below 15%, and the treatment coverage is below 5%, requiring additional funding and investment to address this issue. The literature has proved that it is cost-effective to screen adults for the universal five indicators of hepatitis B [10]. In these countries and even around the world, chronic hepatitis B infection screening should be expanded, so as to improve the diagnostic rate and achieve simultaneous improvement in the diagnostic rate and treatment coverage. On the other hand, except for the Western Pacific region where the infant birth dose vaccination rate reaches 80%, the timely vaccination coverage of birth dose in other regions is relatively low, particularly in the African region, which has the highest prevalence of hepatitis B. In high-income countries, the burden of hepatitis C among drug users in the United States is increasing. Even among diagnosed patients, treatment coverage remains low, highlighting the urgent need to improve the connection to care.