Monitoring of the responses to the hepatitis B and C epidemics in EU/EEA countries, 2023

In 2023, all 30 EU/EEA countries responded to the monitoring questionnaire and provided data for one or more of the questions. Overall, 25 countries were able to provide national data for at least one stage of the continuum for hepatitis B care, although no country was able to provide data across all stages. For hepatitis C, 29 countries provided national-level data for at least one stage of the continuum of care, with four countries providing data across all four key stages of the continuum.

Eight of the 30 EU/EEA countries responding to the 2023 monitoring survey reported no national action plan or strategy for viral hepatitis prevention and control, and only two thirds of the countries with a plan reported available national funding for implementation. Information collected on testing policies or programmes highlighted gaps in relation to testing policies or programmes for hepatitis B virus (HBV) for migrant populations, men who have sex with men (MSM), healthcare workers and people in prison. Similar gaps existed in specific policies or programmes for hepatitis C virus (HCV) testing, with fewer than half of countries reporting policies or programmes for any migrant population or MSM. Self-testing is now reported to be available for HCV in three countries. Only one third of countries reported that tests were available in community and harm reduction settings from peer testers and 80% of countries reported that there were policies that required HBV and HCV tests be performed by healthcare workers. Barriers were also reported in relation to treatment, with 11 countries reporting restrictions, which were mostly in relation to undocumented migrants.

Two countries reported that not all test costs were reimbursed. Information on the costs of tests collected for the first time in 2023 showed considerable variation across countries in the reported costs at the point of access for user (reimbursed or not reimbursed). While costs for treatment were reported to be covered in all countries by the health service or health insurance, there is considerable variation in relation to the reported cost of a month supply of HBV and HCV medication, with a 12-fold difference in costs reported for HBV treatment and a 53-fold difference for HCV treatment.

The estimated proportion of people living with chronic HBV infection by country varied 18-fold, from 277 to 5 055 per 100 000 population. These estimates were derived from a range of methods of varying quality and were often based on studies from before 2016, indicating a need for more robust and up-to-date estimates of burden. The estimated proportion of people living with chronic HCV infection by country varied 46-fold, from 35 to 1 555 per 100 000 population, with most estimates based on the results from a recent multi-parameter evidence synthesis modelling conducted for countries across the EU/EEA.

In terms of progress towards the 2025 interim targets for hepatitis B, none of the four countries with sufficient data are currently meeting the 2025 interim diagnosis target of having 60% of all people living with chronic HBV diagnosed. Five countries provided estimates on the proportion of individuals with chronic HBV infection who had either decompensated cirrhosis and/or hepatocellular carcinoma at the time of diagnosis, with estimates ranging from 1.6% to 17%. Although data from a few countries on numbers tested over time show increasing trends, the overall data indicate that many cases of hepatitis B remain undiagnosed and that high numbers of people with chronic hepatitis B are diagnosed late in the course of their infection, indicating that further efforts are needed to scale up testing and link cases to care.

For the other stages along the HBV continuum of care, including linkage to care, viral suppression, and retention in care among individuals who are ineligible for treatment, the data were also limited, and while this restricts a clear assessment of progress towards the targets it highlights a clear need to improve data reporting. None of the four reporting countries are meeting the interim target of 50% of all people living with chronic HBV receiving antiviral treatment, and while only three countries were able to provide data on the proportion of patients receiving antiviral treatment who are achieving viral suppression, in all three countries viral suppression was high, ranging from 79% to 100%.

For hepatitis C, data availability along the continuum of care was generally greater compared to hepatitis B, but assessing progress towards the targets remains challenging due to gaps in the data and issues with data quality. Only four countries reported complete data to assess progress towards the diagnosis target, of which three countries achieved the 60% diagnosed target. As with hepatitis B, early diagnosis of infection is important to link individuals with chronic HCV to care in order to minimise long-term complications. Data were provided from eight countries on decompensated cirrhosis or hepatocellular carcinoma at the time of diagnosis, and while some estimates were old there was variation across the region, with estimates up to 17% in one country, indicating an urgent need for scaling up testing. None of the five reporting countries are currently meeting the 2025 interim target of 50% of all people living with chronic HCV infection cured. The main reason countries do not meet this target is that a high proportion of the cases of chronic HCV are remaining undiagnosed. Further efforts are also needed to scale up treatment, as data indicated that many diagnosed cases had not been linked to care.