BACKGROUND: Over 38 million individuals are living with HIV, 296 million with chronic Hepatitis B (HBV) and 58 million with chronic Hepatitis C (HCV). Despite successful and cost-effective treatments for these blood-borne viruses (BBVs), over 1.7 million people die per annum. HIV testing is common practise in many countries; yet HBV and HCV screening is often neglected. This systematic review aims to identify the prevalence of these BBVs, and discuss the cost-effectiveness of implementing combined testing and treatment programmes, to justify the need for triple testing on a global scale.
METHODS: MEDLINE, Embase and Global Health were searched to identify papers published between 1/01/2013 and 24/02/2023. Included studies reported the prevalence of HIV (anti-HIV 1/2 antibodies), HBV (Hepatitis B surface antigen) and HCV (anti-HCV antibody). Results were stratified into risk groups: blood donors, general population, healthcare attendees, homeless individuals, MSM, PWUD, pregnant women, prisoners, and refugees.
RESULTS: 175 studies from 56 countries sampling over 14 million individuals were included. The mean prevalence of HIV, HBV and HCV was 3.12%(± 7.71%), 4.01%(±5.80%) and 6.70%(±14.64%) respectively. The mean number of individuals testing positive for at least one BBV was 11.83%(±16.86%). Therefore, if combined testing was implemented globally, for every 3 individuals diagnosed with HIV, another 4 would be diagnosed with HBV and 7 with HCV.

Screenshot 2023-05-03 at 14.54.39.pngPrevalence of HIV, HBV and HCV and the total testing positive for one BBV in included risk groups
CONCLUSIONS: The cost of manufacturing this triple BBV test is $1. Additionally, HIV can be treated for $60/year using TDF/FTC+DTG, HBV for $32/year using generic TDF and HCV can be cured for $79 via generic Sof/Vel, thus providing a cost-effective package solution that could be implemented in the majority of countries. The results of this paper highlight the importance of expanding isolated HIV testing to combination test and treat programmes.

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