Europe’s hepatitis B and C care models have moved, but elimination still trails ambition
Chronic HBV and HCV remain a major public health burden across the WHO European region, where an estimated 29 million people live with long-standing infection. Viral hepatitis-related deaths now exceed those from HIV/AIDS and tuberculosis combined, yet overall mortality has not fallen in step with the availability of prevention tools and antiviral therapy. The gap is not a failure of science. It is a failure of reach, delivery, and continuity of care.
This Series review examines models of care implemented between 2015 and 2025, using scientific literature and policy documents to trace how European systems have tried to move from target-setting toward real-world impact. The central question is not whether effective interventions exist. It is whether health services can find people earlier, confirm infection faster, link them reliably to treatment, and sustain prevention where risk is concentrated.
Simplified pathways are changing access, but access remains uneven
Simplified testing and treatment pathways have become one of the clearest advances in the region. Point-of-care testing, decentralised services, and integrated models tailored to key populations are already proving useful because they compress a fragmented care pathway into fewer encounters. In chronic viral hepatitis, every step lost between screening, confirmatory testing, referral, and treatment initiation becomes a missed opportunity for cure or suppression.
Pragmatic service design matters because HBV and HCV do not behave like conditions that wait for ideal clinic settings. People at highest risk often face unstable housing, incarceration, substance use, migration-related barriers, stigma, or limited trust in healthcare systems. A model that depends on repeated hospital visits and specialist bottlenecks will continue to miss the very groups most likely to carry untreated infection.
The review describes clear benefits from service delivery that moves closer to patients. Decentralised care reduces the distance between diagnosis and action. Integrated pathways also reduce the chance that a positive test becomes a dead end.
Vaccination, harm reduction, and prisons remain central rather than ancillary
For HBV, childhood vaccination remains a foundational prevention strategy, while targeted adult vaccination adds another layer of protection for groups at elevated risk. Those approaches are not interchangeable. Childhood vaccination prevents future reservoir growth, whereas targeted adult vaccination addresses ongoing transmission in populations already exposed to high-risk environments.
Harm-reduction programmes also sit at the center of elimination efforts, especially for HCV. Needle and syringe services, opioid agonist therapy, and other supportive interventions reduce transmission pressure in communities where injecting-related exposure continues to drive new infections. In parallel, prison-based interventions matter because incarceration concentrates risk, diagnosis opportunity, and treatment access in the same setting. When correctional health services link testing to immediate treatment and release planning, they can interrupt chains of transmission that extend beyond prison walls.
A major structural problem persists: many systems still reach people late, after liver disease has already advanced.
Undiagnosed infection remains the biggest barrier to progress
Large undiagnosed populations continue to blunt the impact of otherwise effective tools. The review places strong emphasis on case-finding because elimination cannot advance if infected people remain invisible to the health system. This is especially true for HBV, where chronic infection can remain clinically silent for years, and for HCV, where curative treatment exists but diagnosis often comes too late.
Regional disparities compound the problem. Some countries and local systems have made meaningful gains with streamlined pathways, while others remain constrained by weak data systems, variable political commitment, or limited service integration. These differences are not cosmetic. They determine whether testing happens in primary care, harm-reduction settings, prisons, or only after symptoms emerge in specialist clinics.
Healthcare worker knowledge also remains a limiting factor. Where clinicians are unfamiliar with simplified diagnostic algorithms, current treatment indications, or referral options, patients face avoidable delays. That problem is especially damaging in settings that already struggle with underdiagnosis, since the first contact with care may be the only realistic chance to begin treatment or prevention.
Simplification works best when the entire pathway is redesigned
The strongest message from the review is that isolated interventions do not deliver elimination on their own. Point-of-care testing helps only if positive results lead directly to confirmatory testing and treatment. Vaccination helps only if target groups are identified and reached. Harm reduction helps only if services are consistent, trusted, and adequately funded. Integrated care models perform best when they are built for the realities of key populations rather than for an idealized outpatient workflow.
For HCV, simplified treatment pathways are especially powerful because direct-acting antivirals already make cure possible for most patients. The biological logic is straightforward: once the virus is identified and treatment is started, the window for onward transmission narrows and the risk of downstream liver complications falls. For HBV, long-term suppression and prevention remain essential because chronic infection can persist even when symptoms are absent, silently driving cirrhosis and hepatocellular carcinoma over time.
The challenge now is scale. Small, well-designed pilots are not enough if national systems do not embed them into routine care.
Europe’s 2030 elimination target depends on faster case-finding
The review points toward a clear operational agenda for the next phase of elimination work. Accelerated case-finding must become routine rather than episodic. Broader access to simplified treatment needs to extend beyond specialist centers. Risk-tailored vaccination strategies require better identification of vulnerable groups and more consistent delivery. Stronger data systems are needed to monitor who is being tested, who is being missed, and where treatment breaks down.
These priorities are not abstract. They define whether elimination remains a policy target or becomes a measurable public health outcome. With 2030 approaching, the bottleneck is no longer scientific possibility. The bottleneck is implementation capacity across systems that still fail to connect prevention, diagnosis, and treatment at the speed required.