Impacts of hepatitis B and C prevention programmes on long-term outcomes of advanced liver disease and hepatocellular carcinoma: A systematic review

OBJECTIVES: To synthesise evidence on hepatitis B/C (HBV/HCV) prevention programmes that reduce long-term liver disease and hepatocellular carcinoma (HCC) in high-income countries with opioid misuse, high immigration from endemic regions, and risk-based prevention strategies. STUDY DESIGN: Mixed-methods systematic review. METHODS: MEDLINE, Embase, CINAHL, and Scopus were searched for peer-reviewed English-language studies (January 2013-November 2025). Eligible studies evaluated tailored or enhanced HBV/HCV prevention programmes in high-income countries and reported improvements in liver-related outcomes. Evidence on disease burden, risk factors, programme effectiveness, cost-effectiveness, and facilitators and barriers was synthesised. Study quality was assessed using ROBINS-I and CHEERS. RESULTS: Twenty-three studies assessed prevention strategies including screening, vaccination, early treatment, ongoing liver disease monitoring, and HCC surveillance. Locally targeted community screening identified 15.3%-34.3% of undiagnosed HBV/HCV infections. Integrated care pathways and monitoring programmes enabled detection of advanced fibrosis (5.3%-46.2%) and HCC (3.5%-39.2%). Early treatment reduced long-term disease burden and economic costs. Cross-sector collaboration, community engagement, and integrated care models were notable enablers. CONCLUSIONS: Prevention strategies were shown to improve case finding, early detection of chronic infection and liver damage, linkage to care, treatment uptake, and surveillance adherence. Population-level modelling also demonstrated reductions in long-term disease burden and costs. However, direct evidence that implemented programmes reduce HCC incidence and mortality remains limited, and methodological heterogeneity constrains synthesis. Strengthening evidence on programme effectiveness in preventing advanced liver disease and HCC is needed. Co-designed, patient-centred, integrated programmes spanning the hepatitis-HCC care continuum may enhance equity and maximise prevention benefits when implemented at scale.