Barriers to Viral Hepatitis Elimination and New Strategies to Overcome Them in Low- and Middle-Income Countries.

Chronic infections with hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are major causes of cirrhosis and hepatocellular carcinoma (HCC) worldwide. The greatest burden is borne by low- and middle-income countries (LMICs). Despite the availability of highly effective preventive tools, simplified diagnostics, and affordable antiviral therapies, progress toward the World Health Organization's (WHO) goal of eliminating viral hepatitis as a public health threat by 2030 is insufficient in most LMICs. Gaps persist throughout the entire care continuum, from vaccination and the prevention of mother-to-child transmission to screening, confirmatory testing, linkage to care, treatment initiation, and long-term follow-up. Structural weaknesses in health systems, limited laboratory infrastructure, centralised models of care, financial constraints, stigma, and fragmented disease-specific programmes continue to hinder large-scale implementation. This article examines the main barriers encountered across the viral hepatitis care cascade, from prevention and testing to treatment and long-term follow-up. It discusses practical approaches to overcoming them, including simplified diagnostic and treatment pathways, point-of-care and near-point-of-care technologies, self-testing, integrated testing platforms, decentralised care, and task sharing. Attention is given to the prevention of mother-to-child transmission, the needs of populations underserved by conventional healthcare systems, and comorbidities that influence liver disease progression. In conclusion, technological advances alone will not be sufficient. Progress will also depend on stronger health systems, decentralised models of care, and the integration of viral hepatitis services into existing healthcare programmes.