Barriers across the hepatitis B and C care cascade in India: a narrative review of recent evidence

Abstract

Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are leading causes of cirrhosis and hepatocellular carcinoma in India. Despite an effective HBV vaccine and curative HCV therapy, progress toward the World Health Organization (WHO) 2030 elimination targets has lagged, largely owing to persistent gaps across the care cascade. This narrative review synthesises recent evidence (2020-2026) from Indian peer-reviewed literature, national programme documents, and international agency reports to characterise barriers affecting screening and diagnosis, linkage to care, treatment initiation, retention, surveillance, and prevention. Barriers operate at multiple, interacting levels. At the community level, limited awareness, stigma, low perceived risk, and the asymptomatic course of infection suppress testing demand. At the health-system level, inadequate diagnostic infrastructure, workforce shortages, fragmented service delivery, and heterogeneous programme implementation delay diagnosis and treatment. Although antiviral therapy is provided free under the National Viral Hepatitis Control Programme (NVHCP), out-of-pocket costs for travel, investigations, and follow-up reduce sustained engagement. Weak patient-tracking and fragmented reporting systems contribute to losses along the continuum, while suboptimal timely hepatitis B birth-dose coverage and low vaccination uptake among high-risk groups perpetuate transmission. Recent Indian experience nevertheless identifies effective models, including integrated “one-stop” district services, decentralised hub-and-spoke delivery, and community-led same-day test-and-treat programmes for marginalised populations. Scaling these approaches, alongside strengthened active linkage, standardised national cascade reporting, and improved operational delivery of the hepatitis B birth dose, will be essential to accelerate hepatitis elimination in India.