Background: Liver cancer is the fourth leading cause of cancer death worldwide. According to the 2015 Global Burden of Disease Study, alcohol, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the three main causes of hepatocellular carcinoma (HCC). We assessed diagnostic practices for these risk factors in >50 HIV clinics across the world.
Methods: Cross-sectional web-based survey among HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA); 55 HIV clinics from 31 countries in 6 different regions participated. Data were collected from December 2014 to September 2015.
Results: The majority of sites were from low-income countries (36%) or lower-middle-income countries (31%), with 3 (5%) from high-income countries. Thirty-eight (69%) sites were tertiary-care facilities and 44 (80%) were located in urban settings. Sites followed over 550,000 HIV-positive individuals. Routine HBV testing ranged from 22-100% of sites across regions, and routine HCV testing from 0-80% (Figure). When any HBV testing was performed, 32 (58%) sites used a rapid HBV surface antigen test and 17 (31%) a laboratory-based serological test. HBV viral load was performed in less than 25% of sites across regions. Of the 47 (85%) sites reporting any HCV antibody testing, none used rapid tests and HCV viral load was available in 5 (9%) clinics. Alcohol consumption was routinely assessed in 29 (53%) sites, with 12 (39%) using a structured assessment tool (e.g., AUDIT-C). Five (9%) sites reported having an ongoing screening program for HCC.
Conclusions: Although HBV and HCV testing were conducted in the majority of surveyed HIV clinics, only a minority performed it routinely, with large variation across regions, including across high burden countries. Confirmation of HBV and HCV replication and assessment of hazardous alcohol consumption, the most important modifiable HCC risk factors, were poorly implemented globally.

Screening practices and diagnostic tools for HBV, HCV and alcohol consumption in 55 sites across 6 IeDEA regions
[Screening practices and diagnostic tools for HBV, HCV and alcohol consumption in 55 sites across 6 IeDEA regions]