Diagnostic microbiology and infectious disease · 2026
Diagnostic performance, biological monitoring and care cascade of viral hepatitis in sub-Saharan Africa: a systematic review.
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Kabamba-Tshikongo Arsène, Manya-Mboni Henry, Mwamba-Mulumba Claude, Kabamba-Mukadi Benoit, Longanga-Otshudi Albert
Аннотация
BACKGROUND: Viral hepatitis B (HBV), hepatitis C (HCV), and hepatitis D (HDV) remain major public health challenges in sub-Saharan Africa, where access to diagnosis, biological monitoring, and long-term care is limited. This systematic review synthesized evidence on diagnostic performance, biological monitoring, and the hepatitis care cascade.
METHODS: Following PRISMA 2020 guidelines, we searched six databases for studies published between January 2010 and June 2026. Diagnostic accuracy and observational studies were assessed using QUADAS-2 and the Newcastle-Ottawa Scale, and findings were narratively synthesized.
RESULTS: Fifty-seven studies were included, with a predominance of HBV-focused evidence and substantial heterogeneity across study designs, populations, and diagnostic approaches. HBsAg rapid diagnostic tests showed sensitivities of 88.5-99% and specificities above 93%. Molecular testing remained essential but poorly accessible. Dried blood spot technologies showed promising agreement with plasma-based assays, although performance varied across assay platforms and viral-load ranges. Major gaps occurred between screening, confirmatory testing, treatment initiation, and follow-up.
CONCLUSIONS: Strengthening access to molecular diagnostics, decentralized testing, and linkage to care is essential to accelerate viral hepatitis elimination in sub-Saharan Africa.
METHODS: Following PRISMA 2020 guidelines, we searched six databases for studies published between January 2010 and June 2026. Diagnostic accuracy and observational studies were assessed using QUADAS-2 and the Newcastle-Ottawa Scale, and findings were narratively synthesized.
RESULTS: Fifty-seven studies were included, with a predominance of HBV-focused evidence and substantial heterogeneity across study designs, populations, and diagnostic approaches. HBsAg rapid diagnostic tests showed sensitivities of 88.5-99% and specificities above 93%. Molecular testing remained essential but poorly accessible. Dried blood spot technologies showed promising agreement with plasma-based assays, although performance varied across assay platforms and viral-load ranges. Major gaps occurred between screening, confirmatory testing, treatment initiation, and follow-up.
CONCLUSIONS: Strengthening access to molecular diagnostics, decentralized testing, and linkage to care is essential to accelerate viral hepatitis elimination in sub-Saharan Africa.