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

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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No funding was provided for the datacollection or preparation of this manuscript. The point-of-care tests used in the study were provided by the Pan-American Health organisation as stated in the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was granted by the commission for scientific research in Suriname (CMWO) with document number CMWO30/23. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes No legal or ethical restrictions to be addressed concerning our data availability. All original data is stored in a online database with is also downloaded to an Excel sheet.