HIV and hepatitis can both be treated and suppressed very effectively although only hepatitis C can be functionally cured today. Yet millions of people worldwide remain unaware that they are infected. Without diagnosis, treatment cannot begin, and people with the infection can transmit it to others. Expanding access to testing is therefore central to global efforts to end HIV and viral hepatitis as public health threats by 2030.

In 2022, the World Health Organization adopted coordinated global strategies aimed at ending HIV and viral hepatitis as public health threats by 2030. The global ambition for HIV is often expressed as zero new HIV infections, zero AIDS-related deaths and zero discrimination. WHO’s 2030 targets for viral hepatitis include a 95% reduction in new chronic hepatitis B infections, an 80% reduction in new hepatitis C infections and a 65% reduction in deaths from both, compared with 2015.

In this article, we explore why identifying undiagnosed HIV and viral hepatitis infections is critical to meeting the 2030 goals, and how decentralized testing, together with alternatives to conventional venous blood collection, may help extend testing to populations that are not easily reached by conventional healthcare services.

HIV and hepatitis: progress and remaining challenges

According to recent estimates from WHO, 41 million people were living with HIV globally at the end of 2025. During that year, approximately 1.2 million people acquired HIV and 570,000 died from HIV-related causes. Although 88% of people living with HIV knew their status, millions worldwide remained unaware that they were infected and were therefore unable to benefit from treatment.

Because HIV may not cause obvious symptoms for a prolonged period of time, testing is the only way to determine whether infection has occurred. Importantly, effective antiretroviral therapy (ART) can suppress HIV to an undetectable level, at which point a person living with HIV will not transmit the virus sexually, reinforcing the importance of early diagnosis and access to treatment.

According to WHO’s Global Hepatitis Report 2026, viral hepatitis also continues to cause a substantial global burden, particularly hepatitis B and C, which together account for more than 95% of hepatitis-related deaths (1). That report estimates that 47 million people were living with active hepatitis C infection in 2024, while approximately 900,000 people acquired the infection that year and 240,000 died from hepatitis C-related cirrhosis or liver cancer. Although hepatitis C-related deaths have dropped by 12% since 2015, new infections have declined by only 8.1%.

Diagnosis and treatment coverage also remain low. Between 2015 and 2024, only 36% of people with hepatitis C had been diagnosed and 20% had received treatment, despite the availability of direct-acting antiviral therapy that can cure approximately 95% of infections. Unlike HIV, which can be effectively suppressed but not currently cured, hepatitis C can be cleared from the body through successful treatment, preventing onward transmission provided no new exposure occurs. In 2024 alone, an estimated 11 million people had been diagnosed with hepatitis C but were still awaiting treatment.

Expanding testing to hard-to-reach populations

Despite the availability of effective testing and treatment, many people at increased risk of HIV and hepatitis face barriers to accessing healthcare. These may include people who inject drugs, people experiencing homelessness, people in prisons, migrants and sex workers.

WHO’s 2022 Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations highlight how criminalization, stigma and discrimination, including within healthcare settings, can delay diagnosis and reduce uptake of testing and engagement with treatment (2). A recent review of progress towards the 2030 HIV goals similarly argues that success to date has often relied on people using conventional health facilities, and that greater attention must now be given to populations that are not being reached, through novel approaches and partnerships with local communities (3).

Needle and syringe programs as part of the solution

People who inject drugs are at particularly high risk of acquiring HIV and viral hepatitis because sharing needles, syringes or other injecting equipment can transmit both viruses. Needle and syringe programs are therefore an important part of the public health response. By providing sterile injecting equipment, such programs help reduce transmission risk while also creating opportunities to offer testing, counseling and referral to treatment.

Because these services are often delivered in community settings, they may also reach people who do not regularly engage with conventional healthcare services.

Decentralized testing beyond conventional healthcare settings

Decentralized testing brings services closer to the communities most affected by HIV and hepatitis rather than relying solely on hospitals or specialist clinics. Testing may be offered through community organizations, outreach services, mobile units, harm-reduction programs and other local settings. WHO guidance highlights community-based and community-led services as important ways to increase the accessibility and acceptability of testing and treatment, particularly for people who may experience stigma in traditional healthcare environments (2).

These services can also integrate several forms of support in one place, including HIV and hepatitis testing, prevention, counseling and referral to treatment. Peer workers may play an important role in outreach, helping people to navigate services and remain engaged with care. Real-world programs have shown that community-based hepatitis C screening can be successfully delivered in settings such as markets, places of worship and universities, while targeted programs have expanded testing among people who use drugs and people in prisons (1).

By reducing the need to attend a separate clinical facility, decentralized testing can help prevent missed opportunities for diagnosis and shorten the pathway from testing to treatment.

When venous blood collection becomes a barrier

Even when testing is available in community settings, conventional venous blood collection may still create practical barriers. Some people who inject drugs may have difficulty with venous access, while others may avoid blood draws because of discomfort, anxiety or past negative experiences. Venous sampling also requires trained phlebotomists and suitable facilities, which can limit its use in outreach, mobile and other decentralized settings.

Finger-prick microsampling offers an alternative that can bring sample collection closer to the individual. Small capillary blood samples may be collected in community settings or, depending on the testing strategy, at home and returned to a laboratory for analysis. Dried microsamples can also be easier to store and transport than liquid blood, reducing dependence on rapid handling and cold-chain logistics. Volumetric microsampling may therefore support more flexible HIV and hepatitis testing pathways by enabling standardized capillary blood collection outside conventional clinical settings.

References

1. Global hepatitis report 2026. Geneva: World Health Organization; 2026. Licence: CC BY-NC-SA 3.0 IGO.
2. Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
3. Abdool Karim Q, Mayer KH, Mohan J, Del Rio C. The audacious goal to end AIDS by 2030: aspiration or reality? J Int AIDS Soc. 2024 Jul;27(7):e26339.