Despite seeing a reduction in the prevalence of Hepatitis C (HCV) over the last 14 years, Mongolia has remained the world leader in mortality rates for liver cancer, and prevalence of Hepatitis B (HBV) and D(HDV). 

In 2017, the Government of Mongolia launched its national Healthy Liver Program (HLP) to control viral hepatitis. In 2018, one year after HLP’s launch, 40% of those over age 15 across Mongolia had been screened for HBV and HCV. As of April 2022, 51% had been screened. The slowing momentum for the HLP can be partially attributed to COVID-19 which left Mongolia in lockdown for almost two years, and multiple changes throughout Mongolia’s leadership. 

In 2017, in support of the HLP, FIRE launched its “Hepatitis Free Mongolia,” project, funded by Gilead Sciences, Rotary International, and donors like you. Phase 2 of “Hepatitis Free Mongolia” is focused in Sukhbaatar province, in the far southeast corner of Mongolia, sharing 1/3 of its border with China and with 65,828 registered residents living throughout its twelve counties. 

Now, what was planned to be a one-year program is starting its fourth year! Since the launch of Phase 2 in late 2020, we weathered two years of COVID-19; four Mongolia Minister of Health changes; one Sukhbaatar Governor change; countless Director of Sukhbaatar Health Department changes; complete staff turnover in several remote clinics; significant cost increases for insurance and treatment due to changes in the national health insurance policy; medication scarcity; and a zud (a freezing, harsh storm that devastates animals and herds) that killed more than 300,000 head of livestock and stopped most activities. 

This collaborative program aims to fill the gaps in Mongolia’s national HLP and reinvigorate the fight to end hepatitis by providing a replicable model for HCV elimination across a province. We added a few key activities to Phase 1’s comprehensive mobile liver health screening model to make the elimination of HCV possible. 

Our mobile screening includes testing for HBV, HCV and liver cancer, by utilizing blood tests, ultrasound, FibroScan, physical examinations by hepatologists and oncologists, counseling and education, and connection to specialized care and treatment. We travel to every healthcare facility in the province, ensuring every community member can access the screening program. 

For Phase 2, we also leveraged Mongolia’s extensive social service network and supported those who could not afford health insurance. Key activities included: 

• Utilizing Mongolian’s national registration system, which gives every citizen a unique numerical identifier (like a social security number) and assigns them to a local social worker and primary health care clinic. 
• Select social workers, health care workers, and volunteers were trained to be Hepatitis Coordinators (HC). HCs ensure every community member assigned to them is screened and treated by locating and following them through the process. They also provide education and conduct awareness-raising activities.
• Creating a database at www.hepatitisfreemongolia.com for Hepatitis Coordinators and project leaders to track community members through screening and treatment.
• Covering the insurance and treatment costs for those residents who tested positive for HCV but could not afford the treatment. About 30% of provincial residents are uninsured. 

We have completed most of our screening activities, with at least 76% of the available citizens of Sukhbaatar province having been tested for HBV and HCV. At least 8% of the registered citizens have proven unavailable due to death, or moving. We will start screening high school students in 2024 who make up about 5% of the population.



We are researching and contacting the remaining population with the help of the Hepatitis Coordinators. Mongolia maintains multiple patient databases through the Ministry of Health, National Insurance Agency, Provincial Health Department, and clinic paper records. We are working with each database and the individual clinics to cross-reference these. 

Of the people who tested positive for HCV through FIRE’s screening activities, 95% have received or are in the process of completing HCV treatment until they are cured. The remaining 5% are people who are in poor health or advanced disease and opted not to complete treatment. We are also researching everyone who tested positive for HCV before FIRE’s activities in the province to confirm their treatment status. We will facilitate their 3-month treatment as needed.

The World Health Organization’s (WHO) definition of elimination requires screening 90% of a community and treating 80% who test positive. 

We are very close. We will continue researching and screening until we reach 100%. Our new (hopeful) target date for completion is summer 2024.