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Doctor with pregnant lady in a doctor's surgery

Lecture : 3 min

16 septembre 2026

SANTÉ COMMUNAUTAIRE ET MONDIALE

Article

When Every Day Counts: Bringing Hepatitis B Testing Closer to Care

A field pilot in Uganda shows how decentralized HBV testing can shorten the path from diagnosis to action, helping clinicians identify women eligible for prophylaxis while there is still time to intervene.

In many developing countries, a pregnant woman can easily follow medical recommendations.

She attends antenatal care. She accepts hepatitis B screening. She follows her healthcare provider's recommendations.

Despite this, the results may still be too late.

For mothers living with hepatitis B, viral load testing plays a critical role in identifying who may benefit from antiviral prophylaxis to help prevent transmission to their babies. Yet in many low-resource settings, that test often depends on centralized laboratory systems, where samples travel long distances, and results can take days to return.¹,²

A recent study from Uganda identified an alternative approach. Decentralizing viral load testing with the Xpert® HBV Viral Load assay enabled clinicians to receive same-day results.³

 

The real problem is not diagnosis but rather delay.

One of the most common ways through which hepatitis B infection spreads is mother-to-child transmission. The positive side is that there are solutions to this problem. The World Health Organization, recommends antiviral prophylaxis for pregnant women with high HBV viral loads to help prevent perinatal transmission of hepatitis B.²

The key challenge is identifying eligible women early enough for interventions to be most effective.

"Most chronic hepatitis B infections that lead to liver cirrhosis and liver cancer result from infections that happen perinatally through cancer transmission from mother to child; the mother knowing their status is very critical to avert this averse outcome."

Dr. Linda Kisaakye PMTCT program coordinator at the Ministry of Health, Uganda.

In Uganda, viral load testing is typically conducted through a centralized laboratory network. According to previous research cited in the study, the median time between sample collection and receipt of results can reach 48 days.³

For women nearing delivery, a 48-day delay may limit opportunities for timely prophylaxis.

"Pregnancy is time-limited, and so interventions need to be given in a timely manner. If results are delayed even for a few weeks or months, the mother will have delivered, and it will be too late. A few weeks or months makes a big difference."

Dr. Linda Kisaakye PMTCT program coordinator at the Ministry of Health, Uganda.

Bringing the laboratory closer to the patient

Researchers repurposed existing infrastructure, eliminating the need to develop a new testing system..

Uganda has an extensive network of GeneXpert® systems used for tuberculosis, HIV, HPV, and COVID-19 testing. The study evaluated whether the same platform could be used to provide hepatitis B viral load testing directly within maternal health services.³

In 10 hospitals, healthcare workers integrated the Xpert HBV Viral Load assay into routine antenatal care, allowing testing and clinical decision-making to occur in closer succession.³

"Existing technology for point-of-care testing, already in use for other disease testing like TB and HIV would also make a big difference for mothers and babies."

Dr. Linda Kisaakye PMTCT program coordinator at the Ministry of Health, Uganda

The results were significant

Among 181 pregnant women tested, 92% of results were returned to providers on the same day, and 61% of mothers received their results on the day of sample collection.³

In resource-constrained settings characterized by long travel distances and limited opportunities for repeat visits, same-day testing and result delivery may strengthen care continuity by enabling prompt clinical action and improving linkage to care.

 

Turning faster answers into clinical action

The purpose of testing is not only to generate results, but to enable timely clinical action.

Researchers found that 12% of women tested had viral loads above 200 000 IU/mL, making them eligible for antiviral prophylaxis according to national guidelines.³

Among women with follow-up records, nearly 78% of eligible mothers received prophylaxis. Additionally, 73,3% of newborns with documented outcomes received a hepatitis B birth dose vaccine.³

There were also some challenges noted. Some of the participants were lost during follow-up, and there were challenges related to supply chain problems, among others, at the facilities. ³

Despite the challenges, healthcare workers always appreciated having results while the patients were in the clinic.

 

A practical path forward

Notably, faster access to results did not significantly increase costs.

The study estimated the cost of point-of-care viral load testing at USD 15,37 per test, compared with USD 15,26 through the centralized testing pathway.³

Researchers also found complete concordance between the Xpert HBV Viral Load assay and the centralized reference platform at clinically relevant thresholds, reinforcing confidence in the quality of results generated closer to the patient.³

For countries already using GeneXpert systems for multiple diseases, these findings suggest an opportunity to expand hepatitis B viral load testing without building new infrastructure.³

 

Not only a lab test result

The outcomes from Uganda go beyond just the diagnostic test.

They underscore the significance of minimizing the gap between the test results and further decision-making on patient care.

When doctors have test results in a matter of hours, compared with weeks, conversations and clinical decisions take place promptly, enabling timely action to help prevent mother-to-child transmission. 

Clause de non-responsabilité : Le contenu présenté sur cette page est destiné à des fins informatives et éducatives. Bien qu’elle soit disponible à l’échelle mondiale, elle peut refléter les pratiques cliniques ou les considérations du système de santé spécifiques à une région particulière.

 

Références :

1. World Health Organization. Global hepatitis report 2024: action for access in low- and middle-income countries. Geneva: Organisation mondiale de la Santé ; 2024. Disponible sur : https://www.who.int/publications/i/item/9789240091672

2. World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection. Geneva: Organisation mondiale de la Santé ; 2024. Disponible sur : https://www.who.int/publications/i/item/9789240090903

3. Nabitaka LK, Kasone V, Olal E, Kyokushaba J, Kasibante P, Nambozo S, et al. Optimizing hepatitis B diagnosis for mothers in a low-resource setting: A field pilot of Xpert point-of-care viral load testing in Ugandan antenatal clinics. PLOS Global Public Health. 2026;6(5):e0006380. Disponible sur : https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006380

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