Enhancing access to treatment and programmes for viral hepatitis in an endemic country: a narrative review of literature from 2000 to 2025 (Mongolia)

Background: Mongolia continues to experience the world’s highest incidence of hepatocellular carcinoma (HCC), driven by chronic hepatitis B (HBV) and hepatitis C (HCV) infections. In response, the Mongolian Government has implemented comprehensive public health interventions, including the national ‘Healthy Liver Programme,’ to reduce viral hepatitis transmission and liver-related morbidity. This narrative review aims to evaluate national strategies, progress, and ongoing challenges in HBV and HCV control.Methods: Policy documents from government agencies, WHO, and NGOs were reviewed, along with scientific publications retrieved from PubMed, and Embase using terms such as ‘HBV,’ ‘HCV,’ and ‘treatment access.’ Grey literature was also analysed. The review focused on (i) national strategies and action plans; (ii) programmatic interventions, vaccination, screening, and treatment scale-up; and (iii) reported trends in coverage, treatment uptake, and progress towards WHO 2030 elimination targets. Findings were synthesised by comparing policy commitments with implementation outcomes and triangulating evidence across multiple sources.Results: Forty-four peer-reviewed articles and 12 policy documents were included. Mongolia has achieved >95% infant HBV vaccination and 93.9% hepatitis A coverage, reducing HBsAg prevalence among children under five to 0.3% by 2023. Among adults, HBsAg prevalence declined from 6.9% in 2015 to 5.5% in 2023, while HCV prevalence decreased from 6.7% to 3.7%. More than 120,000 HCV infections have been diagnosed, with over half treated through national initiatives; by 2023, 4,700 HBV and 66,959 HCV patients had initiated therapy. Liver cancer incidence decreased from 39.1% in 2016 to 32.7% in 2021, and annual HCC cases fell from 857 in 2015 to 567 in 2022.Discussion: Mongolia aims to reduce viral hepatitis prevalence by 90% and liver-related mortality by 85% in the coming decade.Conclusion: While substantial progress has been made, strengthened health system capacity and improved monitoring mechanisms are essential to close remaining gaps and accelerate progress towards hepatitis elimination.Summary: Policy implementation: Mongolia implemented several key policies, including the Targeted Prevention and Control Program to Eradicate Viral Hepatitis (1988–2000), mandatory HBV vaccination, and the Healthy Liver programmes (2016–2020 and 2022–2025).Vaccination programmes: Mongolia was among the first to introduce hepatitis B vaccination for newborns in 1991 and added a pentavalent vaccine in 2005. The HAV vaccine was introduced in 2012, with high coverage rates for children under one year.Healthy liver programme: This programme improved access to diagnostic and treatment options for viral hepatitis, including introducing antiviral medicines and reimbursement for antiviral therapy costs through national health insurance.Success achieved: The incidence of total viral hepatitis was reduced to 0.7 per 10,000 population by 2022, surpassing the goal of 10 per 10,000. HBsAg prevalence in children under five met WHO's regional goal, and HCV prevalence among adults significantly decreased.Treatment access: Patients in Mongolia have access to treatments for HBV, HCV, and HCC with significant reimbursement from the Health Insurance Fund. The affordability of these treatments has improved, making them accessible to a larger population.