Preventive strategies for chronic liver disease: A critical review of awareness, vaccine and screening programmes.

Chronic liver disease (CLD) poses a growing public health burden in India, with hepatitis B virus (HBV) remaining a preventable contributor despite the nation's expanding immunization and screening frameworks. This narrative review critically appraises programme-level preventive strategies for HBV-related CLD in India, structured across three tiers of prevention: public awareness, vaccination and screening. Evidence was synthesized from 26 eligible studies, incorporating national surveys, cohort studies, policy reports and qualitative analyses. Findings reveal substantial deficits in HBV-related knowledge, particularly among socio-economically disadvantaged and rural populations, where stigma, mis-information and poor health literacy impede timely diagnosis and care-seeking. Although hepatitis B vaccination is part of India's Universal Immunization Programme, birth-dose coverage remains sub-optimal due to labor-room workflow challenges, cold chain fragility and provider hesitancy, especially in high-fertility states. Uptake among healthcare workers and medical students is also inconsistent, highlighting gaps between theoretical knowledge and preventive behavior. Screening efforts, primarily through the National Viral Hepatitis Control Programme, remain fragmented, with significant inter-state disparities in antenatal HBsAg testing and limited penetration in tribal and remote regions. While decentralized, community-led models have shown promise; broader scale-up is hampered by logistical and infrastructural constraints. The review underscores the urgent need for culturally tailored awareness campaigns, cold chain automation, subsidized adult vaccination and robust digital linkage-to-care models. Generating rural-specific cost-of-illness and willingness-to-pay data will be vital for evidence-informed policymaking. A life-course approach anchored in equity, digital health and decentralization is essential to achieving HBV elimination goals and reducing the burden of chronic liver disease in India.