“B-ZERO” - Accelerating progress towards HBV elimination in Africa by using treatment to deliver aviraemia

Hepatitis B virus (HBV) causes over 250 million chronic infections worldwide, with a disproportionate burden in Africa. Oral nucleos(t)ide analogue (NA) treatment is prescribed to suppress viraemia and curb transmission, but is not curative. New WHO guidelines increase treatment eligibility from 50% of people living with HBV. However, new real-world data suggest one-quarter of those treated may not achieve durable viraemic suppression (VS), for reasons not yet explored. Therefore, the impact of treatment expansion is unknown. B-ZERO will address this evidence gap through three integrated approaches: ● Registry analysis: interrogation of the HEPSANET HBV ‘living registry’, representing 12 African countries, to quantify VS prevalence and identify predictors of treatment outcome. ● Deep phenotyping: longitudinal study of HBV cohorts in South Africa and Ethiopia for laboratory profiling to assess the role of viral genotype, antiviral resistance, drug levels, and liver reservoir in treatment outcome. ● Policy-focused modelling: use of transmission modelling to project population-impact of scaling up HBV treatment in Africa, while incorporating non-VS and drug resistance, to inform intervention strategies. The programme will identify risk factors for treatment failure, reveal mechanisms for persistent viraemia on treatment with actionable interventions, and deliver policy guidance for HBV elimination in Africa.