Interventions to enhance hepatitis B virus (HBV) testing, linkage to care, treatment and vaccination: Protocol for a systematic review and meta-analysis

Background:Hepatitis B (HBV) remains a significant public health concern, with screening and treatment gaps contributing to disparities in health outcomes. Equitable access to HBV care is crucial for reducing morbidity and mortality rates associated with HBV, particularly given diverse population groups at risk of HBV in most countries. However, barriers to accessing timely HBV screening and treatment persist, warranting a systematic review to identify effective interventionsfor improving access.Objectives:This protocol outlines a systematic review aimed at synthesizing the evidence on the effectiveness of interventions aimed at enhancing HBV testing,linkage to care, treatment initiation, as well as treatment continuationand adherence,and vaccination,as well asidentifyingthe implementation strategies used (the ‘activecomponents’ of HBV interventions).Search methods:A systematic review and meta-analysis will be conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Acomprehensive search will be conducted across MEDLINE (PubMed), Scopus, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), along with key trial registries and relevant conference proceedings for studies published from 2012onwards.No geographical or language restrictionswill be applied.Selection criteria:Studies will be screened by two independent review authorsbased on predefined inclusion criteria. Studies will be included if they assess interventions directed at individuals at risk for or living with HBV, healthcare providersor healthcare systems,include a comparator or control; and report one or more HBV-relevant outcomes, such as HBsAg testing uptake, HBV DNA testing uptake, treatment initiation or adherence, or HBV vaccination.Data collection and analysis:Risk of bias for randomized and non-randomized studies will be assessed using the Cochrane Risk of Bias 2 and ROBINS-I tools, respectively. Two reviewers will independently conduct data extraction and appraisal.All descriptions of HBV interventions will be independently coded in NVivo for implementation strategies by two reviewersusing the ERIC Taxonomy encompassing 73 implementation strategies. We will use random effectsmeta-analysis models to calculate the pooled study outcome estimates and conductstratified analyses by study setting, study population and intervention-specific characteristics