Despite effective and safe HBV vaccine and antiviral therapies, HBV-related hepatocellular carcinoma remains a major cause of deaths in young adults in Africa. Barriers to control the burden of HBV infection and HCC are multiple. In comparison to other major infectious diseases, hepatitis B virus infection and liver diseases have received remarkably little attention from the global health community. Improving birth dose vaccine coverage and implementing screening and treatment interventions are urgently needed. This requires a dramatic simplification of the management of chronic hepatitis B in Africa with access to reliable, robust and inexpensive diagnostic tools but also strong support from the local governments and the international health community. This review analyses 1) the characteristics of HBV viral hepatitis and HCC epidemics in Africa and 2) the barriers and requested solutions to control it.