Hepatitis B and Delta and the role of the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado

Hepatitis B and D display a distinctive epidemiological pattern in the Western Amazon, disproportionately affecting Indigenous peoples and riverine populations across Brazil, Peru, Colombia, Venezuela, and Ecuador. Despite more than three decades of universal hepatitis B vaccination, moderate endemicity and a high burden of chronic carriers persist in the region. In the state of Amazonas, Brazil, the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) has played a pivotal historical and contemporary role in the recognition, diagnosis, clinical management, surveillance, and research of HBV and HDV infections, serving as a major reference center for the region. The local health-care network is aligned with national policies but faces substantial challenges related to the vast geographic territory, strong centralization of specialized services in Manaus, and limited availability of trained professionals in endemic and remote areas. Logistical, socioeconomic, and cultural barriers continue to restrict timely access to diagnosis and treatment, while universal vaccination, widespread rapid testing, and ongoing decentralization efforts represent key facilitating factors. Looking ahead, the proposed research agenda emphasizes integrated surveillance, genomic and clinical-epidemiological studies, evaluation of the care cascade, and strengthening of primary health care as essential strategies to reduce regional inequalities and accelerate progress toward the elimination of viral hepatitis by 2030.