Ensuring pragmatic and equitable paths forward for hepatitis B virus infection eradication in Latin America

INTRODUCTION: Latin America occupies a paradoxical position in hepatitis B virus (HBV) elimination: aggregate prevalence is low, yet the region remains far from the WHO and PAHO 2030 targets because the burden is structurally concealed within underserved populations and fragmented health systems. AREAS COVERED: This narrative review examines the regional epidemiological landscape, the structural and programmatic barriers to elimination, and a pragmatic framework focused on populations with concentrated unmet need (indigenous communities, incarcerated and displaced persons, and people living with HIV), alongside perinatal prevention, coinfection with hepatitis D virus, a defective satellite virus that requires the hepatitis B surface antigen to complete its replication cycle and produces the most rapidly progressive form of chronic viral hepatitis, endemic in the Amazon basin, and the balance between simplified and precise diagnosis in low-prevalence settings. We also consider how locally validated, equity-aware computational tools may support case-finding, risk stratification, and investment prioritization. Evidence was identified through PubMed/MEDLINE searches from January 2010 to 30 April 2026, complemented by normative and surveillance sources from WHO, PAHO, and ALEH. EXPERT OPINION: In the WHO Region of the Americas only 23% of people with chronic HBV are diagnosed and 4.5% are treated; closing this gap requires a shift from coverage-centered to precision-centered delivery, that is, reaching the right individuals and coupling decentralization to active linkage to care. HBV elimination in Latin America is best understood as a systems delivery challenge under conditions of low apparent prevalence.