Diagnostic performance, biological monitoring and care cascade of viral hepatitis in sub-Saharan Africa: a systematic review.

BACKGROUND: Viral hepatitis B (HBV), hepatitis C (HCV), and hepatitis D (HDV) remain major public health challenges in sub-Saharan Africa, where access to diagnosis, biological monitoring, and long-term care is limited. This systematic review synthesized evidence on diagnostic performance, biological monitoring, and the hepatitis care cascade. METHODS: Following PRISMA 2020 guidelines, we searched six databases for studies published between January 2010 and June 2026. Diagnostic accuracy and observational studies were assessed using QUADAS-2 and the Newcastle-Ottawa Scale, and findings were narratively synthesized. RESULTS: Fifty-seven studies were included, with a predominance of HBV-focused evidence and substantial heterogeneity across study designs, populations, and diagnostic approaches. HBsAg rapid diagnostic tests showed sensitivities of 88.5-99% and specificities above 93%. Molecular testing remained essential but poorly accessible. Dried blood spot technologies showed promising agreement with plasma-based assays, although performance varied across assay platforms and viral-load ranges. Major gaps occurred between screening, confirmatory testing, treatment initiation, and follow-up. CONCLUSIONS: Strengthening access to molecular diagnostics, decentralized testing, and linkage to care is essential to accelerate viral hepatitis elimination in sub-Saharan Africa.