The American Journal of GASTROENTEROLOGY VOLUME 107 | SEPTEMBER 2012 www.amjgastro.com nature publishing group 1306 REVIEW CLINICAL AND SYSTEMATIC REVIEWS INTRODUCTION Te World Health Organization estimates that globally 350 mil- lion people are chronically infected with the Hepatitis B virus (HBV), with a further four million acute infections every year (1). Sub Saharan Africa, aboriginal Australia, the East Mediter- ranean, South East Asia, South America, the Pacifc Islands, and the Inuit communities of Canada have high Hepatitis B prevalence (2). In United States, despite a policy of universal vaccination, the incidence of HBV infection remains high in marginalized popula- tions—injection drug users, incarcerated populations, and MSM (men who have sex with men) (3). Finally, increases in travel and immigration impact the control of infection in countries with universal vaccination programs (4). Within this context, timely screening for HBV infection in marginalized populations in devel- oped settings, and at-risk populations in endemic settings gain rel- evance for early detection, initiation of treatment and prevention of further transmission to infants, partners, and the community. Te Centers for Disease Control (CDC) recommend diagnos- ing Hepatitis B infection by detecting components of the antigen– antibody response, specifcally by detection of the IgM antibody to the Hepatitis B core antigen (HBcAg), or the Hepatitis B surface antigen (HBsAg), and confrming that the patient is negative for IgM antibodies to the HBV to diagnose acute infection (5). Addi- tionally, they recommend confrming chronic infection if an indi- vidual is negative for IgM antibodies to HBcAg, but positive for HBsAg and total anti-HBcAg (6). Use of the Hepatitis B e antigen Rapid Point-of-Care First-Line Screening Tests for Hepatitis B Infection: A Meta-Analysis of Diagnostic Accuracy (1980–2010) Sushmita Shivkumar, MSc 1,2 , Rosanna Peeling, PhD 3 , Yalda Jafari, MSc 1 , Lawrence Joseph, PhD 2 and Nitika Pant Pai, MD, MPH, PhD 1,4 OBJECTIVES: Three-hundred fifty million people worldwide are chronically infected with Hepatitis B, with four million acute infections annually. With infection concentrated in hard-to-reach populations and low resource settings, rapid point-of-care (POC) tests offer an efficient screening alternative to laboratory tests. We conducted a meta-analysis to evaluate accuracy of rapid POC tests screening for Hepatitis B. METHODS: Two reviewers searched four databases, critiqued quality. A hierarchical Bayesian meta-analysis cor- recting for imperfect reference standards was used. Based on components of the antigen–antibody response, 17 studies were stratified into three subgroups: (i) Hepatitis B surface antigen (HBsAg) tests; (ii) anti-HBsAg tests, and (iii) HBs + eAg tests. Further, we pooled estimates on individual tests with sufficient data. RESULTS: In subgroup 1, the pooled sensitivity (Sn) was 94.76% (95% credible interval (CrI): 90.08–98.23%) and specificity (Sp) was 99.54% (95% CrI: 99.03–99.95%). The Determine test reported a pooled Sn 98.2% (95% CrI: 94.7, 99.9) and Sp 99.9% (95% CrI: 99.3, 100); in subgroup 2, Sn 93.2% (95% CrI: 85.1, 98.5), Sp 93.1% (95% CrI: 81.9, 99.9); and in subgroup 3, the Binax test showed Sn 95.5% (95% CrI: 88.9, 99.4), Sp 99.8% (95% CrI: 99.3, 100). CONCLUSIONS: HBsAg tests, including Determine, and the HBs + eAg test, Binax showed high accuracy. Improve- ments in sensitivity of antibody-based tests will enhance their potential for global first-line screening. SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg Am J Gastroenterol 2012; 107:1306–1313; doi:10.1038/ajg.2012.141; published online 29 May 2012 1 Division of Clinical Epidemiology, McGill University and Health Center , Montreal, Quebec, Canada; 2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University , Montreal, Quebec, Canada; 3 London School of Hygiene and Tropical Medicine, London, UK; 4 Division of Infectious Diseases and Immuno- deficiency Service, Department of Medicine, McGill University and Health Center , Montreal, Quebec, Canada. Correspondence: Nitika Pant Pai, MD, MPH, PhD, Division of Clinical Epidemiology, McGill University Health Centre, V Building, Room V2.09, 687, Pine Avenue West, Montreal, Quebec, Canada H3A 1A1. E-mail: nitika.pai@mcgill.ca Received 7 February 2012; accepted 9 April 2012