The road to achieving viral hepatitis elimination in Suriname: The progress, the challenges and the goals

Abstract

Background: Viral hepatitis is one of the leading causes of liver failure, cirrhosis, hepatocellular cancer and mortality worldwide and has long had limited treatment options. Estimates suggest that around 30% of the global population has at one point been infected with HBV, while 3.9% are chronically infected. 1.6 – 2.8% of the world population is estimated to be infected with HCV. With the introduction of the HBV birth-dose vaccines, HBV immunoglobulins and the more recent development of the HCV direct-acting antiviral medication, HBV and HCV infections have now become containable diseases. In 2016, all 194 member states of the World Health Organization endorsed the public-health goal to eradicate viral hepatitis by 2030. Yet, as of 2023, only a small group of countries are on course to achieving this goal. Suriname, a small, multi-ethnic country, located in the north of South America, has an intermediate prevalence of HBV and HCV of 3% and 1% respectively. Previously performed studies, however, show strong ethnic clustering in Suriname. Aim: With this manuscript we dissect the strategy we developed to tackle the hepatitis challenge in Suriname. We explain the importance of establishing more detailed insight into the geographical distribution of high-prevalence areas, as linked to the ethnic differences in the population. We present the screening and contact tracing approaches and end with our current insights on how to proceed toward further prevention and treatment options. Overall, we provide a blueprint towards eliminating viral hepatitis with simple and effective strategies usable in resource-limited countries with an intermediate to high prevalence of viral hepatitis.