EVOLVE-HBV’ Study: Characteristics and treatment eligibility of adults living with hepatitis B virus infection in rural KwaZulu-Natal, South Africa

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This record contains a poster abstract presented at the European Association for the Study of the Liver (EASL) Congress 2026 held in Barcelona, Spain.The study reports findings from the EVOLVE-HBV study, a population-based investigation of hepatitis B virus (HBV) infection in rural KwaZulu-Natal, South Africa. The World Health Organization has set targets to eliminate viral hepatitis as a public health threat by 2030; however, data on HBV prevalence, disease burden, and treatment needs remain limited in many high-prevalence African settings.Using samples and data from 2,200 participants enrolled in a community-based health survey, the study estimated the prevalence of active HBV infection and evaluated clinical outcomes among individuals with confirmed chronic HBV infection. Participants underwent assessment for liver disease severity, including liver stiffness measurement using FibroScan®, biochemical testing, and evaluation for metabolic dysfunction-associated steatotic liver disease (MASLD). HBV treatment eligibility was assessed according to the 2024 World Health Organization guidelines.The findings demonstrate a high burden of HBV infection in rural KwaZulu-Natal, with substantial levels of liver fibrosis, elevated liver enzymes, and MASLD among participants with chronic HBV infection. The study also highlights important gaps in follow-up and linkage to care. While all individuals with HIV/HBV co-infection were receiving HBV-active antiretroviral therapy, many individuals with HBV mono-infection met WHO treatment criteria but were not receiving treatment.These results provide important evidence to inform HBV elimination strategies in South Africa and other high-burden settings. The study underscores the need for improved HBV screening, diagnosis, risk stratification, linkage to care, treatment access, and integration of liver disease assessment into existing HIV and chronic disease programmes.Conference: European Association for the Study of the Liver (EASL) CongressStudy: EVOLVE-HBV

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