Implementation gaps and policy priorities for viral hepatitis elimination in India

Abstract

Viral hepatitis remains a major public health challenge globally, with India bearing nearly 11.6% of the world’s chronic infections. To align with the World Health Organization’s target of eliminating viral hepatitis as a public health threat by 2030, India launched the National Viral Hepatitis Control Programme (NVHCP), which employs virus-specific strategies including elimination of hepatitis C virus (HCV), reduction of chronic hepatitis B virus (HBV) burden, and strengthened prevention of enterically transmitted hepatitis. Through decentralization of services and provision of free generic direct-acting antivirals (DAAs), the programme has achieved substantial progress, with HCV cure rates exceeding 90% among treated individuals. Despite these gains, several implementation challenges continue to impede progress toward elimination targets. Critical gaps persist in the diagnostic cascade, including limited availability of integrated reflex viral load testing, inadequate access to HBV DNA testing, and the absence of routine hepatitis D virus (HDV) screening among HBsAg-positive individuals. Restrictive HBV treatment eligibility criteria, suboptimal hepatitis B birth-dose vaccine coverage, fragmented surveillance systems, and persistent stigma further undermine programme effectiveness. This persepective article examines the key barriers to viral hepatitis elimination in India and outlines priority policy actions. These include institutionalizing single-visit reflex molecular testing, expanding HBV treatment eligibility in accordance with the 2024 WHO guidelines, strengthening maternal antiviral prophylaxis and birth-dose vaccination strategies, improving outreach to marginalized populations, and integrating digital surveillance and patient-tracking systems to enhance continuity of care. Successful decentralized models, such as Punjab’s hepatitis programme, offer valuable lessons for scaling up effective interventions and accelerating India’s progress toward achieving its 2030 viral hepatitis elimination goals.erspective revi