One Pair of Hepatitis Experts Positioning Uruguay for Success
Dr. Victoria Mainardi & Dr. Solange Gerona
A disease that’s been deemed a “silent epidemic” claims more than a million lives each year. Viral hepatitis—primarily hepatitis B and C—rivals HIV, tuberculosis and malaria in its toll but receives far less attention and funding. It can go undetected for decades until causing severe liver damage or cancer. In 2016, the World Health Organization set an ambitious goal: to eliminate viral hepatitis as a public health threat by 2030. While global progress has been uneven, Uruguay has quietly emerged as a leader in the Americas region, expanding access to testing, treatment and vaccination.
Two doctors have become driving forces behind the country’s efforts, combining scientific expertise with an unwavering commitment to improving access to care, with their sights set on elimination. Dr. Victoria Mainardi and Dr. Solange Gerona worked with the Coalition for Global Hepatitis Elimination, a program of The Task Force for Global Health, to include Uruguay in the Coalition’s Hepatitis Evaluation to Amplify Testing and Treatment (HEAT) project, which supports countries by creating a modeling tool to combine epidemiological data and laboratory capacity assessments to develop a budget-based plan to eliminate viral hepatitis.
SCROLL DOWN FOR FULL STORY
Dr. Mainardi (second from the left) and Dr. Gerona (first from the right) speaking at the official celebration of World Hepatitis day by the Ministry of Health in Uruguay in 2023. Photo courtesy of the Ministry of Public Health, Uruguay.
In 2021, in response to a call from Uruguay Ministry of Health’s HIV/STI Program Coordinator Dr. Renée Diverio, and with support from The Pan American Health Organization/World Health Organization, Dr. Mainardi and Dr. Gerona led the development of Uruguay’s first national hepatitis B and C clinical guidelines.
“This process revealed major barriers, such as fragmented data and lack of coordination,” said Dr. Mainardi. “The HEAT modeling tool helped us define the problem, project scenarios and craft evidence-based strategies.”
Their work has allowed for greater access to testing, treatment and care for hepatitis B and C, resulting in a healthier, more informed population. Both Dr. Mainardi and Dr. Gerona were named Elimination Champions by The Task Force for Global Health’s Coalition for Global Hepatitis Elimination for their achievements.
Dr Gerona, Chief of The National Liver Transplant Program of Uruguay, along with Dr. Mainardi, Dr. Olivari (co-leaders of the Viral Hepatitis Unit) and the rest of the staff. Photo courtesy of Dr. Victoria Mainardi.
Dr. Mainardi, an internist and hepatologist, has dedicated more than a decade to Uruguay’s National Liver Transplant Program and the Hepatology Service at the Central Hospital of the Armed Forces. She has played a pivotal role in developing Uruguay’s first national hepatitis guidelines, advocating for expanded access to diagnosis and treatment, and simplifying administrative processes.
“We hope to help Uruguay achieve the elimination of viral hepatitis as a public health threat,” she said. “That includes strengthening hepatitis policies, updating national guidelines, expanding vaccination and screening, and ensuring surveillance and care remain robust and sustainable.”
As the first hepatologist to formally join the Ministry of Health’s HIV/AIDS-Sexually Transmitted Infections Program, Dr. Mainardi has played a key role in securing two major policy advances. Due to her efforts, the national policy requires that she ensure a recommendation for all adults to be tested at least once for hepatitis C. Also, to ensure that patients did not have to pay for testing, Dr Mainardi successfully promoted the inclusion of hepatitis C testing into Uruguay’s Comprehensive Health Care Plan (PIAS).
Dr. Gerona, a specialist in gastroenterology and hepatology, has been at the forefront of Uruguay’s liver health initiatives and also played a key role in developing the first national hepatitis guidelines with Dr. Mainardi. As the Chief of the National Liver Transplant Program since 2009 and Head of Hepatology at the Central Hospital of the Armed Forces, Dr. Gerona spearheaded Uruguay’s first epidemiological study on hepatitis C and promoted vaccination against hepatitis A and B. As an advisor to the Ministry of Public Health, Dr. Gerona continues to enhance hepatitis diagnosis and treatment strategies.
“Our work has had a national impact by helping shape public health policies that improve population health,” said Dr. Gerona. “These policies are long-term, system-wide, and are owned and implemented by the country, not just by individuals or teams.”
Thanks in part to these two remarkable doctors, Uruguay is setting an example for other countries to follow, with evidence that hepatitis elimination is achievable, especially when policymakers are invested. “By developing and institutionalizing protocols, clinical guidelines, and public health policies that are integrated into the national health system and budgeted at the country level, we are building local capacity and ensuring national ownership,” said Dr. Gerona. “This is essential for sustainability.”