Diagnostic performance, biological monitoring and care cascade of viral hepatitis in sub-Saharan Africa: a systematic review.

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.