Optimizing Hepatitis B screening: A comparison of ELISA and rapid tests

Hepatitis B remains a major global public health problem, particularly in areas of high endemicity such as Madagascar, where prevalence exceeds 8%. Diagnosis relies primarily on the ELISA immunoenzymatic technique, which is recognized for its reliability but is not widely available in resource-limited laboratories. Rapid diagnostic tests (RDTs) offer a practical alternative, but their performance in this context has yet to be evaluated. This prospective descriptive and analytical study compared the performance of the Virucheck® rapid test and the Wantai Bio Pharm ELISA for the detection of hepatitis B virus surface antigen (HBsAg). The sample consisted of 74 serum samples from patients with sickle cell disease and subjects followed at the JRA University Hospital. The results showed a seroprevalence of 6.75% by TDR versus 9.45% by ELISA. The TDR had a sensitivity of 71.41% and a specificity of 100%, while the ELISA confirmed its superiority with sensitivities exceeding 95% and specificities close to 98%. Beyond technical performance, the study highlighted a predominantly young population, reflecting the significance of mother-to-child transmission, as well as a notable seroprevalence among young adults linked to risky sexual behaviors. These findings underscore the urgency of early and targeted screening, combined with a strengthened vaccination strategy. In conclusion, optimizing hepatitis B screening in Madagascar relies on the complementary use of rapid tests—suitable for community-based screening—and ELISA, which is essential for diagnostic confirmation and clinical follow-up. This approach represents a strategic pathway to reduce transmission, improve vaccination coverage, and strengthen the fight against hepatitis B in a context of high endemicity.