Editorial: Viral hepatitis elimination: Still a big challenge: Care is not only for C

Abstract

The global fight against viral hepatitis started in 2016 and, based on the WHO's strategy to reduce infection rate by 90% and deaths by 65% until 2030, has made significant strides recently. Despite this fact, the Global Hepatitis Report in 2024 reveals that viral hepatitis killed over a million people last year, so there is still a lot of job to do to overcome barriers worldwide.^{1, 2} In this context, independent of every country's politics, microelimination efforts have proved quite effective and useful.

Under this aim, the authors of a recent paper in AP&T used an intelligent method to identify hepatitis patients (not only C but also B and D) who were not linked to care.³ They retrieved the records of 3731 patients from the Central Laboratory database of the Northern Barcelona Health Area and identified an alarming gap between diagnosis and management of hepatitis cases. Respectively, 38% HBsAg, 29% anti-δ positive and 59% HCV RNA positive individuals did not receive the appropriate care. The disconnection between diagnosis and healthcare delivery demonstrates how intricate it is to deal with chronic viral hepatitis, whereby the impediments differ according to patient populations affected.¹

Next, the authors proceeded a step further and tried to reintegrate the lost patients by systematically identifying and contacting them (up to 5 telephone calls and by post!). Finally, 47.2% of eligible patients (64% hepatitis B, 27% C and 100% D) were successfully linked to care. This is one of the most impressive aspects of the study that looks into whether a targeted intervention strategy is effective or not. The results can be considered a great success, especially regarding the ‘new (old) kid in town’—hepatitis D, which is mostly underdiagnosed but happens to be in the most severe among viral hepatitis infections.

So, can even the most challenging cases be brought back into care with the right approach? This is less true regarding hepatitis C patients, who present considerable difficulties in re-engaging. In fact, social factors such as instability, unwillingness to use healthcare services and outmoded beliefs about treatment challenges contributed to a lower success rate. All interventions targeting this population should therefore encompass more than clinical strategies to address the social determinants of health that impede patient engagement.⁴ Better coordination of patient data across regions is one key recommendation to help keep track of patients who move and maintain continuity of care. Additionally, closer integration of social services with health care can provide the necessary assistance to bring back socially marginalized patients as well as those who have lost trust in the healthcare system.

As the global health community continues its efforts to eliminate viral hepatitis, there is a clear reminder of how far we have to go.⁵ However, this type of research provides useful insights into overcoming obstacles by addressing barriers to linkage to care and developing interventions that are tailored for different target populations with any type of viral hepatitis.

Nikolaos Papadopoulos: Writing – original draft; investigation; resources. Melanie Deutsch: Supervision; writing – review and editing; conceptualization.

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This article is linked to Vargas-Accarino et al paper. To view this article, visit https://doi.org/10.1111/apt.18227.