Peer-reviewed article
National guideline for hepatitis B elimination in Thailand: a decentralized health system model for expanding diagnosis and treatment.
Phunchai Charatcharoenwitthaya, Tawesak Tanwandee, Pisit Tangkijvanich, Teerha Piratvisuth, Chatree Jullapetch et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a clinical guideline for hepatitis B management in Thailand's health system, focused on adult diagnosis and treatment strategies. The guideline addresses chronic hepatitis B among adults born before vaccine implementation through screening, treatment eligibility criteria, and long-term care protocols. While it mentions mother-to-child transmission prevention, the document is primarily directed at adult health systems and does not evaluate child-specific interventions or outcomes for child well-being.
Key points
- Thailand's 2026 hepatitis B guideline prioritizes birth-cohort HBsAg screening for adults born before 1992
- Prevention of mother-to-child transmission uses HBV DNA-guided antiviral prophylaxis
- Guideline incorporates non-invasive fibrosis assessment and simplified treatment eligibility criteria
- Implementation framework integrates with antenatal services, HIV programs, and primary care facilities
- Strategy uses high genetic-barrier nucleos(t)ide analogs as first-line treatment
Limitations
This document is a clinical guideline focused on health system implementation rather than evaluation of child health outcomes. It does not provide data on the effectiveness of interventions for children's health or well-being, nor does it assess impact on child survival, development, protection, or participation.
Abstract
Despite sustained universal infant hepatitis B vaccination, chronic hepatitis B (CHB) remains an important cause of cirrhosis and hepatocellular carcinoma in Thailand, particularly among adults born before vaccine implementation. This article summarizes the 2026 National Guideline on Elimination of Viral Hepatitis B in Thailand and presents a health-system framework for addressing the remaining disease burden. The guideline was developed by a multidisciplinary expert panel using evidence from international recommendations, peer-reviewed literature, national epidemiological data, implementation studies, and health economic analyses. The recommendations were formulated using the GRADE framework and adapted for implementation within Thailand's Universal Health Coverage system. The national strategy prioritizes birth-cohort HBsAg screening for adults born before 1992, simplified evidence-based treatment eligibility incorporating non-invasive fibrosis assessment and virological criteria, and first-line use of high genetic-barrier nucleos(t)ide analogs. Prevention of mother-to-child transmission prioritizes HBV DNA-guided antiviral prophylaxis, with simplified implementation pathways reserved for settings with substantial diagnostic constraints. Long-term care emphasizes structured monitoring, appropriate specialist referral, conservative treatment discontinuation criteria, defined retreatment thresholds, and risk-based semiannual ultrasound surveillance for hepatocellular carcinoma. Integration with antenatal services, HIV programs, and primary care facilities supports decentralized delivery and continuity of care. Thailand's 2026 hepatitis B guideline operationalizes evidence-based CHB management within a publicly financed decentralized health system and provides a scalable model for expanding hepatitis B diagnosis and treatment in endemic settings.