Successful Amendment of an Existing Hepatitis B Screening Programme by a Guideline Recommended Hepatitis D Screening in the Primary Care Setting

BackgroundDespite European guidelines recommending anti‐hepatitis D virus (HDV) screening for all hepatitis B surface antigen (HBsAg)‐positive cases, screening rates remain insufficient.AimsWe analysed anti‐HDV screening rates in primary care and implemented prospective HDV screening in HBsAg‐positive cases identified in the preventive medical examination from the age of 35 (“Check‐Up 35+”).MethodsFrom 2012 to 2021, we reviewed anti‐HDV and HDV RNA test rates in HBsAg‐positive patients at 11 sites of a large German laboratory group. From 2022 to 2023, we prospectively screened HBsAg‐positive samples from the “Check‐Up 35+” for anti‐HDV. Anti‐HDV positive patients were then contacted again for HDV RNA testing.ResultsRetrospectively, 2792/13,905 (20%) HBsAg‐positive cases were tested for anti‐HDV, with 142/2792 (5.1%) being positive. HDV RNA was tested in 57/142 (40%) anti‐HDV‐positive cases, with 26/57 (46%) being positive. In the prospective screening, 1159/225,901 (0.51%) individuals were HBsAg‐positive. Of these, 700 (60%) were tested for anti‐HDV, with 18/700 (2.6%) positive test results. 4/18 (22%) were successfully contacted again for HDV RNA analysis, with one case testing positive. Neither the HBsAg nor the anti‐HDV positive result was known prior to screening in these cases. Anti‐HDV testing could not be performed in 459/1159 (40%) HBsAg‐positive cases, primarily due to insufficient blood sample volume (310/459 cases, 68%), with others missed due to logistical errors.ConclusionsRetrospective data show insufficient anti‐HDV screening in clinical routine. The prospective anti‐HDV screening provides a blueprint for using existing hepatitis B virus screening programms for population‐based HDV double reflex testing, provided that adequate logistical prerequisites are established.Trial RegistrationGerman Clinical Trial Register: DRKS00029180