World Hepatitis Day 2025 — What India's Diagnostics Say About Hepatitis Readiness

On World Hepatitis Day 2025, explore how India's diagnostic evolution, from ELISA to portable PoC molecular platforms, is shaping our readiness against Hepatitis B and C.

India’s rural health mission advances with rapid Hepatitis testing tools.

Source : Canva

{By: Dr Ajeet Singh Bhadoria}

Every year on July 28, World Hepatitis Day is observed, and for India, it marks a monumental moment for introspection on how India is dealing with one of its major public health problems. Along with chronic infections from Hepatitis B (HBV) and Hepatitis C (HCV) with over 40 million Indians suffering, India is facing a silent epidemic. While highlighted factors such as receiving proper treatment and vaccination matters, one of the fundamental responses, which is often clogged, is being prepared diagnostically. The archaic diagnostic patterns are now starting to illuminate critical changes regarding infrastructure, accessibility, and innovation.  

The Evolution Of Hepatitis Diagnostics In India

The past two decades have greatly changed the flow of hepatitis diagnosis in India. The systems have changed from quite slow, centralised systems to much faster, decentralised systems, allowing for much greater efficiency.  

For example, initially, the testing for hepatitis B in India was limited to referral center based antigen assays, in which hepatitis B surface antigen (HBsAg) was detected through ELISA. These tests confirmed identification of the infected individuals, but the tests had to be done in fully equipped laboratories which in rural India was often out of reach. In addition, the fully equipped laboratories would take days to return any results which added on to the already datable diagnosis for rural individuals.  

As demand for testing increased, HBsAg was detected through lateral flow formats embedded in referral center based rapid diagnostic tests (RDTs). While the tests allowed for faster results, the efficiency and accuracy of the results was greatly lacking.  

With the advent of portable molecular diagnostic systems, India has experienced a transformational shift in the healthcare landscape in the last five years. These systems perform HBV DNA and HCV RNA detection and quantitation with real-time sensitivity. They integrate RT-PCR's accuracy with the level of decentralisation and speed offered by point of care (PoC) devices. The systems have been incorporated into various national and state programs which have greatly improved access in remote and underserved regions. With battery-operated portability, automation in sample processing, and low training prerequisites, health workers have the ability to diagnose infections in the field. Molecular point of care platforms like Truenat and others have improved the diagnostic and treatment gap by providing results within an hour, shortening the detection-intervention window. This is especially beneficial for community and maternal surveillance.

What Still Needs Strengthening

Gaps in diagnostics still exist. Hepatitis screening services are still lacking for a significant portion of the population, especially in the North-Eastern and tribal regions. Antenatal HBV screening at pregnancy diagnosis is a mandated practice by the WHO, but has not yet been fully adopted at the country level. In addition, while molecular PoC devices are available, their usage in PoC is not uniform across states due to cost, fragmented procurement systems, and a lack of adequate training infrastructure.  

Furthermore, the integration of data from diagnostics and the national health information systems is still subpar in the area of information consolidating. Many diagnosed cases from independent labs do not make it to central registries, and that compromises the efforts of national surveillance. Also, there is a lack of standardised and updated protocols for oversight and management after a diagnosis has been made—many people diagnosed with the condition are not managed or treated.

What Is On The Horizon?

The next steps in the evolution of hepatitis diagnostics within the Indian context involves merging broad-based scalability, interoperability, and integration. The following are the goals to progress:  

• Validate and connect HMIS at the state level and Ayushman Bharat Digital Mission for data untethering and digitisation.  
• Streamline the supply chains and local production of test kits to improve regional and national access.  
• Authorise and educate community health workers to perform and interpret PoC tests accurately and independently.  
• Create more efficient multiplex test platforms for the simultaneous detection of HBV, HCV, HIV, and TB.  

While the observance of World Hepatitis Day serves as a catalyst, it remains a work in progress: there is still work that needs to be done. The transformative nature of diagnostics in India’s health system remains thought-provoking, with the shift from waiting for tests to receiving results from sophisticated point of care test systems and molecular test systems coming is elaborate. To claim this vision with equity, harnessing data systems that work in real-time targeting every community is the vision. The 2030 mark for elimination remains elusive though: timely, proactive, and strategic scaling of access are crucial to early intervention.

The author, Dr Ajeet Singh Bhadoria, is Additional Professor, Community Medicine And Faculty incharge at Preventive Hepatology, AIIMS Rishikesh.

[Disclaimer: The information provided in the article, including treatment suggestions shared by doctors, is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]