Comprehensive Prevention and Control Service Capacity for Hepatitis B in Medical and Health Institutions: A Cross-Sectional Survey in Jiangsu Province, China
A 2025 cross-sectional survey of 183 medical institutions in Jiangsu Province reveals that while HBV laboratory testing capacity is robust, particularly for HBsAg, comprehensive treatment and follow-up services remain heavily concentrated in tertiary hospitals, highlighting a critical need to strengthen primary-level participation and coordination across the prevention and control service chain.
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Hepatitis B is a virus that attacks the liver, often silently, for decades before causing serious damage like cirrhosis or cancer. For a long time, the world has known that preventing this virus is possible through vaccination, but stopping the damage it causes in people who are already infected requires a different kind of effort. It demands a continuous chain of care: finding the virus in a person's blood, confirming the diagnosis, referring them to a specialist, providing medicine to stop the virus from multiplying, and then checking in regularly for the rest of their lives. In many places, this chain is broken. A patient might get tested at a small clinic but never hear back, or they might be told to see a specialist but have no clear path to get there. The goal of global health organizations is to eliminate this virus as a public health threat, but that goal cannot be reached if the medical system itself is not ready to handle the patients it finds.
In 2025, researchers in Jiangsu Province, a large and economically developed region in China, decided to map out exactly how well their local medical system was handling this chain of care. They did not look at patients directly; instead, they visited 183 different medical institutions, ranging from small local clinics to massive university hospitals, as well as the public health centers responsible for tracking disease. Their mission was to see if these places had the tools, the staff, and the procedures to manage Hepatitis B from the moment a test is ordered to the final follow-up visit. They wanted to know if the system worked as a unified whole or if it was a collection of disconnected parts.
The survey revealed a system that is very strong at the beginning but struggles as it moves forward. The researchers found that the ability to test for the virus is widespread. Nearly 87 percent of the institutions they visited could perform the initial blood test that detects the virus's surface protein. In 2025 alone, these facilities conducted over 3.75 million of these tests. However, the work was not shared equally. The vast majority of these tests, more than 90 percent, were done in the largest, most advanced hospitals. The smaller, local hospitals did very little of this testing. When it came to the next step, a more complex test that measures the actual amount of virus in the blood, the gap widened. Only about 57 percent of the institutions could perform this second test, and every single small hospital had to send their samples out to a different laboratory to get the results.
The pattern of inequality continued as the researchers looked at treatment. While the large hospitals were fully equipped to prescribe the medicines needed to suppress the virus, the smaller hospitals were largely left out. Only about 19 percent of the primary hospitals offered antiviral treatment, compared to nearly 87 percent of the tertiary, or large, hospitals. Almost all the patients receiving this life-saving medication were being treated in the big city hospitals. The same concentration appeared in long-term care. Managing a patient with Hepatitis B requires regular check-ups to ensure the medicine is working and to watch for side effects. The study showed that only about one-third of the hospitals provided this kind of follow-up management, and again, the work was almost entirely concentrated in the largest hospitals. The smaller clinics, which see patients every day, were rarely involved in this long-term care.
Another significant finding was that the system was not very good at connecting the dots between these different steps. When a patient was diagnosed, only about 37 percent of the institutions had a formal process to refer them to a specialist. Many of these referrals were just verbal instructions given to the patient, with no written form or direct contact between the doctors. Even when a referral was made, fewer than half of the institutions checked to see if the patient actually made it to the next appointment. The public health centers, which are supposed to coordinate the overall effort, were mostly focused on counting cases and tracking data rather than helping patients navigate the system. This created a situation where a patient might get a positive test result at a local clinic, be told to go to a big hospital, but then fall through the cracks because no one was actively guiding them or following up.
The researchers concluded that while Jiangsu Province has built a powerful engine for detecting the virus, it has not yet built the road that leads from detection to cure. The system relies too heavily on the largest hospitals to do the heavy lifting of testing, treating, and monitoring, leaving the local clinics underutilized and disconnected. The study suggests that to truly control the virus, the medical system needs to change how it operates. It needs to bring the ability to treat and manage patients down to the local level, create clear and reliable pathways for sending patients between clinics and hospitals, and ensure that public health officials and doctors are working together to keep patients in care. Without these changes, the gap between finding the virus and curing the patient will remain, and the goal of eliminating the disease will stay out of reach.
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