How Primary Care Can Close the Hepatitis B Testing Gap, With Cary James

World Hepatitis Day falls each year on July 28, marking a global effort to close persistent gaps in hepatitis B diagnosis and care. A survey funded and commissioned by GSK, conducted online among approximately 5000 adults across Canada, Japan, Taiwan, China, and Germany, found that public understanding of chronic hepatitis B (CHB) remains strikingly limited.

Among the 1061 Canadian adults aged 18 to 54 and older surveyed, only 31% rated CHB a high cancer risk, even though the virus accounts for up to 56% of liver cancer cases globally. Nearly 9 in 10 respondents reported being unaware or knowing very little about CHB, and 45% of Canadian adults said they have never been tested because they had not considered doing so or did not believe they were at risk.

Among individuals considered at higher risk for CHB, nearly half said they do not intend to get tested, and separate findings show that 80% of at-risk individuals have never heard of CHB, with roughly 7 in 10 remaining untested. Misconceptions about prevention persist as well: 55% of Canadians incorrectly believe there is no treatment for CHB, and about 3 in 4 are unaware that vaccination offers protection.

In the following Q&A, Cary James, CEO of World Hepatitis Alliance, discusses what this awareness gap means for how primary care clinicians should approach hepatitis B risk assessment and what practical steps can help normalize CHB testing during routine visits:

Patient Care Online: The survey found that 80% of at-risk individuals have never heard of CHB, and nearly half don't believe they're at risk or simply don't know. From a primary care standpoint, what does this awareness gap mean for how clinicians should be approaching hepatitis B risk assessment during routine visits, rather than waiting for patients to raise concerns themselves?

Cary James: There's several ways in primary care to address this, right? You could have a protocol in place depending on how hepatitis B is manifested in that particular country. If there are certain populations that are more at risk, maybe certain migrant communities from high prevalence countries, first or second generation, or even key populations, you can put a protocol in if someone comes in for even a routine visit in primary care that they would be offered a hepatitis B test. This kind of comes back to whether those primary care physicians feel comfortable with doing that, or whether those people are familiar.

It should just be routine. In most countries, hepatitis B tests are not that expensive, especially lab tests, so it should just be part of a general healthy living range of tests or things that are checked at least once in their life. In Germany, they have a policy that everyone should be tested at least once in their life. I think that is the protocol, and that would really make a huge difference. Sometimes, if you make an exception about something, then it makes it more scary. Streamlining it in primary care in the same way that they're talking about with HIV services in primary care. TB is talking about the same thing, like MDCV services.

The main conversation about how we're going to solve the issues around decreased international funding in developing countries, but even in high income countries, is that things have to be evolved when they can in primary care, and hepatitis B is exactly the same.

Patient Care Online: With 7 in 10 at-risk individuals remaining untested, what practical steps can primary care clinicians take to identify at-risk patients and normalize CHB testing?

Cary James: I think it's kind of what I said before, right? If you know the communities in your catchment area of your clinic that may be affected by viral hepatitis, if you have some communities that are disproportionately affected, put some information in your waiting rooms. Talk to the patients about it during routine visits, and maybe put a protocol in place that all people from those communities are offered a test when they're also doing other kinds of routine tests. I think it's really important to normalize it as much as we can and take the stigma away from it.

I think that once people know about it and know about the cancer risk, they want to get tested. They don't want to have something that they think might cause cancer. So, if you explain it in a way that's sort of like that, without prejudice, and this is just something that's important for you to know because no one wants to get cancer, then I think it's a much more appealing proposition than if you just talk about it as a singular concern.

It is often associated with sexual transmission, which unfortunately still has lots of baggage on it around promiscuity and all kinds of stuff it doesn't deserve. I think the more you can normalize it and make the information available and make it part of the day-to-day care, the more applicants you'll get.

Editors’ Note: Cary James is chief executive officer of the World Hepatitis Alliance.

References

1. GlaxoSmithKline Inc. New survey reveals Canadians underestimate chronic hepatitis B and its link to liver cancer. July 28, 2026. Accessed July 28, 2026. https://www.newswire.ca/news-releases/new-survey-reveals-canadians-underestimate-chronic-hepatitis-b-and-its-link-to-liver-cancer-840531048.html

2. US Centers for Disease Control and Prevention. About World Hepatitis Day. Accessed July 28, 2026. https://www.cdc.gov/hepatitis-awareness/about/world-hepatitis-day.html