The Hepatitis Delta Global Landscape

The World Hepatitis Alliance (WHA) is calling for targeted educational programs for community-based organisations and policymakers to increase knowledge and foster stronger advocacy for more informed policy development to identify and combat hepatitis delta which affects 12 million people worldwide.

A global survey conducted by the WHA found that the biggest barrier to increasing diagnosis and treatment of hepatitis delta is widespread lack of awareness among healthcare providers, policymakers and at-risk communities.

Over 38 per cent of respondents had low levels of familiarity with hepatitis delta. Almost half of respondents in community organisations, and close to 39 per cent of policymakers, reported low levels of hepatitis delta knowledge. One in six health care providers (about 16 per cent) reporting being “not at all familiar” with hepatitis delta.

The Hepatitis Delta Global Landscape Survey by the World Hepatitis Alliance received responses from 583 individuals from 102 countries. Almost 60 per cent of community workers who responded worked in the hepatitis sector, and 50 per cent of health care provider respondents were gastroenterologists, hepatologists or infectious disease specialists.

Hepatitis delta – also known as hepatitis D – is a virus that survives only in the presence of hepatitis B. People co-infected with hepatitis B and hepatitis D are at greater risk of progressing to liver cancer and faster progression to liver cirrhosis, compared to those living with chronic hepatitis B only.

Despite these serious outcomes, there remains a lack of data on hepatitis D, exceptionally low awareness about the virus, and little access to screening and treatment, the survey report said. Advocates and stakeholders lack the knowledge and data needed to secure funding, push for change and implement programs.

“The evolving landscape of hepatitis delta diagnostics and treatments has led to the development of varying international guidelines, including recommendations from the European Association for the Study of the Liver (EASL) and updated World Health Organization (WHO) guidelines on hepatitis B treatment,” the report said, adding that “to implement the testing and treatment strategies outlined in these guidelines and reach those most in need, existing barriers to access must be addressed.”

A third of respondents did not feel sufficiently informed to identify barriers to hepatitis delta testing and treatment

The survey looked at awareness, knowledge, testing, treatment, and barriers to the last two. The key findings were:

• There are significant gaps in knowledge and awareness of hepatitis delta among community-based organisations, policymakers and HCPs.   

• HCPs reported low levels of training around hepatitis delta, and most expressed a clear interest in further education on the topic.  
• Regionally there are disparities in levels of knowledge, and large variations in availability and accessibility of hepatitis delta testing and treatment.  
•  Lack of knowledge is reported as the most significant barrier to both testing and treatment.   

• A third of respondents did not feel sufficiently informed to identify barriers to hepatitis delta testing and treatment, further reinforcing the impact that a lack of knowledge is having to scaling up responses.   
•  Even where hepatitis delta testing and treatment are reported to be available, accessibility remains a significant challenge.  
•  Both direct and indirect costs are reported as significant barriers to equitable access to hepatitis delta treatment and care. 

 Following on from these findings, the World Hepatitis Alliance is calling for:

• Increase both availability and accessibility of testing and treatment for hepatitis delta in health systems.
• Address the issues of direct and indirect costs of testing and treatment to increase engagement by communities.
• Adopt testing policies to follow WHO recommendations on reflex testing for hepatitis delta.
• Inform people living with hepatitis B of the need to test for hepatitis delta through culturally competent awareness campaigns.
• Provide more robust training on hepatitis delta to healthcare professionals throughout their career progression.
• Increase provision of knowledge and awareness programmes for community-based organisations and policymakers.
• Implement skills-building programmes for community-based organisations so they can better advocate to policymakers and public health officials for greater access to testing, treatment and care.

Stressing the urgent need to increase awareness and enhance accessibility to testing and treatment for hepatitis delta, the report said, “These insights reinforce the necessity of targeted awareness campaigns, accessible diagnostic options, and financial support to improve the reach and impact of hepatitis delta-related healthcare services globally.”

“A failure to address these will put individuals at a higher risk of late-diagnosis, advanced liver cancer and liver-related death.”

Last updated 16 May 2025

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