The tools to eliminate viral hepatitis exist and are cheap. Vaccination prevents hepatitis B, direct-acting antivirals cure hepatitis C in twelve weeks, and diagnostics have been simplified repeatedly. Progress towards the WHO's 2030 elimination goal is nevertheless insufficient in most low- and middle-income countries, which carry most of the burden. This review examines why.
The losses are spread across the whole cascade rather than concentrated at one step: vaccination coverage, prevention of mother-to-child transmission, screening, confirmatory testing, linkage to care, treatment initiation, and long-term follow-up. Each transition loses patients, and the cumulative effect is that a large majority of infected people are never treated. The causes named are structural - weak laboratory infrastructure, care centralised in tertiary hospitals, out-of-pocket cost, stigma, and vertical disease-specific programmes that do not talk to each other.
The proposed remedies are equally structural: simplified diagnostic and treatment pathways, point-of-care and near-point-of-care testing, self-testing, integrated testing platforms that screen for several infections at once, decentralised care, and task sharing with non-specialist staff. The authors are explicit that technological advance alone will not close the gap.
For Indian practice this is the most directly applicable paper on the desk today. The National Viral Hepatitis Control Programme has the drugs; what determines whether a patient in a district hospital is cured is whether confirmatory testing is available locally, whether treatment can be started without a referral to a medical college, and whether anyone follows up. Those are the things a gastroenterologist can influence through how their service is designed, and the paper is a checklist for that conversation.
- Audit your own cascade: how many diagnosed patients actually start treatment, and how many finish
- Push confirmatory testing towards point of care - the referral for a viral load is where patients are lost
- Support task sharing: hepatitis C treatment does not require a specialist for most patients
- Screen antenatal women for hepatitis B and check the birth-dose vaccine is actually given
- Integrate hepatitis testing with existing HIV and tuberculosis programmes rather than running it separately
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for gastroenterology & hepatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free