World Gastroenterology Organisation Practice Guidelines

Significant progress on hepatitis B treatment pathways has been made since the last World Gastroenterology Organisation (WGO) guidelines in 2015. Global elimination targets have been set, prioritizing the prevention of new infections and optimizing screening and linkage to care in resource-limited settings. This has been led by the World Health Organization (WHO), which first published hepatitis B treatment and care guidelines in 2015 and updated its recommendations in 2024. The critical importance of preventing new infections was supported in 2020 by the WHO policy brief guidelines on antiviral prophylaxis for the purpose of preventing mother-to-child transmission of hepatitis B. A commitment by the global community to support maternal and infant health with the goal of triple elimination of HIV, HBV, and syphilis was established with the first WHO country guidance in 2025. Updated regional liver society guidelines [American (AASLD), European (EASL), Latin American (ALEH), and Asia Pacific (APASL)] have supported application of HBV management to regional contexts, with a focus on simplification and expansion of treatment eligibility. However, consensus on a clear roadmap for HBV guidance that may be broadly adopted in global, resource-limited settings remains elusive. The WGO guidelines are unique in their global lens with evidence-based recommendations, and where evidence is limited, expert opinions have been sought from leaders with broader global representation. Cascade-of-care algorithms ensure optimal access to hepatitis care. The opportunity to consider a test-and-treat approach is also discussed when access to the diagnostic assessment tools is unavailable (particularly in high-burden settings). The main purpose of this document is to provide a simple, easy-to-follow framework for global hepatitis B care pathways, particularly in lower-resource settings. Broadening treatment eligibility, using simplified tools, and, where required, delivering care in a decentralized model with limited test results is encouraged. Key statements that address the main issues at hand were prepared based on prevention, testing, treatment, and monitoring. Invited panel members were asked to grade recommendation statements with adjustments made on repeat voting until concordance was reached. Seminal papers for review are referenced, and supportive tool kits for implementation.