REVIRAL: ROADMAP FOR THE ELIMINATION OF VIRAL HEPATITIS IN LATIN AMERICA

Abstract

Introduction and Objectives

Viral hepatitis elimination remains a major challenge in Latin America due to disparities in access to diagnosis, treatment, and follow-up. The REVIRAL study aims to assess disease burden, evaluate healthcare delivery models, and propose strategies to achieve elimination targets.

Materials and Methods

REVIRAL is a multicenter, retrospective study combining database review and prospective surveys targeting healthcare professionals and patient organizations across 22 countries. Key focus areas include: hepatitis B, C, and D epidemiology in high-risk groups; identification of diagnosed but untreated individuals; evaluation of screening methods for the general population; analysis of national plan coverage; availability of diagnostic tools and treatment access; and implementation of microelimination strategies in priority settings.

Results

Findings reveal major disparities in regional responses. Thirteen countries report a national plan, but implementation varies. Health systems range from full public coverage to patient-funded models. Serology for hepatitis B and C is widely available, but molecular testing is fully accessible in only 10 countries. Universal high-risk screening exists in five nations but lacks territorial consistency. Six countries have microelimination strategies in prisons or dialysis centers, though not widespread. Treatment is free in nine countries; elsewhere, patients bear significant costs, with uneven coverage. Hepatitis B vaccination rates are optimal (≥75%) in only 10 countries. Treatment registries are scarce, limiting impact evaluation. Access delays range from 2–6 months. Despite effective therapies, only 10–20% of diagnosed patients receive treatment, indicating persistent economic, administrative, and equity barriers.

Conclusions

REVIRAL highlights the urgent need to strengthen surveillance systems, enhance inter-agency coordination, and promote equitable access to care. Key recommendations include establishing real-time monitoring, optimizing patient identification, and tailoring strategies to each country's context.