Progress and challenges in the comprehensive management of chronic viral hepatitis: Key ways to achieve the elimination

Table 1 World Health Organization's goals to achieve viral hepatitis elimination and strategies to make it

Goal to 2030	Existing resources	Barriers	Strategies that should be improved
Hepatitis C
90% reduction of new viral hepatitis infections	Harm reduction programs: Safe-sex, safe-needles, and safe-syringes	If well, programs exist in the real-life world are not always sufficiently implemented	Target high-risk population such as MSM, prison inmates, sexual workers, patients with HIV, IDU, immigrants, children born from an HCV+ mother
To reach 90% of patients with viral hepatitis infections being diagnosed	Tests with high sensitivity	If well, detection campaigns exist, it is not enough to reach all people in a real-life setting	Once in life, universal screening for all adults. Also target high-risk population such as immigrants, MSM, prison inmates, sexual workers, patients with HIV, IDU, children born from an HCV+ mother
65% reduction in liver-related deaths	DAAs. Telemedicine and telementoring programs	Still, there is limited access to therapy. More restrained access in LMICs. Vulnerable groups with high prevalence and incidence of viral hepatitis have restricted access to therapy	Flexible policies that guarantee timely access to treatment to all who need it, including vulnerable groups such as immigrants, prison inmates, sexual workers, patients with HIV, IDU, children born from an HCV+ mother when appropriate. Consider including those without healthcare insurance to cover their medication. Encourage telemedicine programs to access communities of difficult access
Hepatitis B
Prevention of new HBV infections through vaccination and blood safety	Effective and safe vaccine	In the real-life world they are not always available or schemes are applied incompletely	Programs that effectively ensure universal and complete schemes of vaccination at birth for infants and later for those who did not receive the vaccination in childhood. Coverage should be extended and also prioritized for vulnerable groups
Identification, linkage to care, and treatment of persons with chronic HBV	Serologic HBV panels. Nucleos(t)ide analogs with a highly effective and high barrier to resistance Telemedicine and telementoring programs	Serologic HBV panels for diagnosis sometimes are restricted to specialists. Still, there is limited access to therapy, more restrained in LMICs. Vulnerable groups with high prevalence and incidence of viral hepatitis have restricted access to therapy	Basic diagnostic tests (HBsAg and anti-HBc) should be available at primary healthcare. More flexible policies that guarantee timely access to treatment to all who need it, including vulnerable groups such as immigrants, prison inmates, sexual workers, IDU, children born from an HCV+ mother when appropriate. Consider including those without healthcare insurance to cover their medication. Encourage telemedicine programs to access communities of difficult access

anti-HBc: Antibody against hepatitis B core antigen; DAAs: Direct antiviral agents; HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B virus; HCV+: Positive to hepatitis C virus; HIV: Human immunodeficiency virus; IDU: Injecting drug users; LMICs: Low and middle-income countries; MSM: Men who have sex with men.