#20 - Reviral-Latam: A Multinational Survey on Viral Hepatitis Elimination in Latin America

Introduction and Objectives Viral hepatitis remains a leading cause of cirrhosis and hepatocellular carcinoma globally. Implementation of the WHO 2030 elimination agenda across Latin America and the Caribbean (LAC) remains heterogeneous. REVIRAL-LATAM was conducted under the auspices of the Latin American Association for the Study of the Liver (ALEH) to evaluate policies, clinical practices, structural barriers, and implementation gaps in viral hepatitis elimination across the region. Patients and Methods Multinational cross-sectional study using a REDCap-based questionnaire adapted from the Hep-CORE framework (171 variables across ten thematic domains—including governance, diagnosis, treatment, screening, micro-elimination, surveillance, and innovation). Data were collected between May–September 2025, with country-level stratification and construction of a Global Elimination Index (IGE). Results A total of 475 valid responses from 19 LAC countries were analyzed; awareness of national elimination plans was reported for HCV - 67.6% respondents, HBV - 59.1%, and HDV - 11.0%. Test-and-treat implementation remained limited (HCV 19.5%, HBV 13.7%, HDV 3.2%), despite broad availability of simplified HCV treatment (81.5%). Leading barriers included public misinformation(93.1%), insufficient healthcare professional training(86.0%), territorial inequalities(84.8%), lack of prescribing training(81.3%), and hospital-centered care models (77.3%). Coverage was particularly low for indigenous populations(21.8%), migrants(25.5%), and homeless individuals(29.4%). Telemedicine(25.6%), and re-linkage programs(11.4%) remained isolated initiatives. The IGE revealed marked regional heterogeneity(23.7%–55.6%). Conclusions The principal regional gap is implementation capacity, not therapeutic availability—particularly in decentralized diagnosis, surveillance, vulnerable populations, and integrated care. HDV remains the most neglected elimination component. Reflex-testing, simplified treatment pathways, and micro-elimination strategies should be prioritized toward WHO 2030 targets.