Characterizing trends and associations for hepatitis C virus antibody prevalence in the Middle East and North Africa: meta-regression analyses

Prevalence of hepatitis C virus infection in Qatar's resident population based on a national screening campaign

Hepatitis C virus (HCV) infection poses a global health challenge, yet its epidemiology in Qatar remains underexplored. This study estimated HCV antibody (Ab) prevalence in Qatar and examined associated socio-demographic factors. From January 2017 to December 2019, the Ministry of Public Health conducted a national HCV awareness and surveillance campaign. A total of 81,615 individuals, including both Qatari nationals and expatriate residents from 137 countries, underwent HCV antibody testing using the Elecsys Anti-HCV II electrochemiluminescence immunoassay. Probability weights were applied to adjust for age, sex, and nationality, to the testing sample. Logistic regression assessed factors associated with HCV Ab positivity. Among individuals tested, 1149 were positive, 80,299 were negative, and 167 were indeterminate. The estimated HCV Ab prevalence in the study sample was 1.4% (95% CI 1.3-1.5%). The weighted HCV Ab prevalence in the resident population of Qatar was also estimated at 1.4% (95% CI 1.2-1.7%). HCV Ab positivity was strongly associated with age, with higher adjusted odds ratios (AORs) in older individuals. Disparities were noted among certain nationalities, with Bangladeshis and Tunisians having lower odds of infection, while Pakistanis, Egyptians, and Yemenis had higher odds of being infected. Males had a 1.97-fold (95% CI 1.47-2.65) higher odds of being HCV Ab positive compared to females. The considerable HCV Ab prevalence in Qatar underscores the need for targeted interventions, prevention and harm reduction strategies, and expanded testing and treatment programs to advance progress toward the 2030 elimination target.

The impact of restricted community accessibility on needle and syringe sharing among drug users in Baise city: based on the event study method

OBJECTIVE

To investigate the effect of the restricted access to clean needles and syringes on needle and syringe sharing behavior like Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) amongst the people who inject drugs (PWID) in Baise, Guangxi province of China, and to provide the scientific evidence for formulating public health policies aimed at preventing HIV transmission.

METHOD

Using the national unified questionnaire and plan, from 2010 to 2019, snowball sampling was conducted among the community drug users under sentinel surveillance in Baise City's county districts every April to June. During face-to-face interviews with each participant, a structured questionnaire was used to collect demographic, behavioral, and venous blood for serological surveillance. All of this information was input into the HIV/AIDS Comprehensive Response Information Management System (CRIMS). Following China's enforcement of the Regulation on Supervision and Administration of Medical Devices(hereinafter referred to as the Regulation) in June 2014, which limited the sale of clean needles and syringes by community pharmacies. Therefore, we divided the period from 2010 to 2019 into from 2010 to 2015 and from 2016 to 2019. Utilizing the trends of HIV/HCV prevalences during these periods and taking them as indicators to measure the occurrence of needle and syringe sharing behavior. Employing the Event Study Method to verify the influence of community accessibility to needles and syringes for individuals of traditional drug users(TDU) on needle and syringe sharing, focusing on cumulative abnormal positive rates as a key metric. TDU came from the National HIV/AIDS CRIMS in 2010-2019 as the object, whose trend changes of annual HIV/HCV prevalences serve as a generation indicator of needle and syringe sharing. We set the period from 2010 to 2015 as the estimation window and from 2016 to 2019 as the event window, using the Chi-square trend tests to examine the changing trends in annual HIV/HCV prevalences. To construct a linear regression model based on the HIV/HCV prevalences from 2010 to 2015, the model was used to predict the expected prevalences from 2016 to 2019, which were compared with the actual prevalences from 2016 to 2019 to calculate the abnormal prevalences and the cumulative abnormal prevalences. Robustness tests were conducted on the cumulative abnormal prevalences to exclude the random changes in prevalences.

RESULT

In the event window, The actual trend of HIV/HCV prevalences were both statistically significant from 2010 to 2015(trend2 = 7.479, P = 0.006 and trend2 = 9.717, P < 0.001), but weren't both statistically significant from 2016 to 2019(trend2 = 0.604, P = 0.437 and trend2 = 0.134, P = 0.715). The Linear regression model indicates the HIV prevalence showed a negative correlation with time(adjusted R2 = 0.911, P < 0.001), and the HCV prevalence also exhibited a negative correlation with time from 2010 to 2015(adjusted R2 = 0.869, P < 0.001). During the event window from 2016 to 2019, the expected HIV and HCV prevalences were as follows: for HIV, 8.24%, 5.62%, 3.01%, and 0.39%; for HCV, 34.55%, 30.56%, 26.56%, and 22.57%. The abnormal HIV/HCV prevalences during this period were: for HIV, 3.29%, 6.26%, 9.56%, and 7.88%; for HCV, 4.71%, 10.69%, 15.28%, and 14.35%. The cumulative abnormal HIV/HCV prevalences were 3.29%, 9.55%, 19.11%, 26.99% for HIV, and 4.71%, 15.40%, 30.68%, 45.03% for HCV; the robustness test results indicated that the changes in HIV and HCV prevalences during the event window were not random events(U = 12.371, P < 0.001 for both Cumulative abnormal HIV/HCV prevalence).

CONCLUSION

When individuals practice injecting drugs, the important factor in needle and syringe sharing among TDU groups is the restricted access to clean needles and syringes from the community. The community commercial channel for needles and syringes should serve as a public health resource, addressing access to clean needles and syringes for individuals and reducing the frequency of needle and syringe sharing among community-active TDU groups. Public health policies aimed at preventing HIV epidemics in TDU populations should fully consider the accessibility of needles and syringes for the TDU groups in the community, thereby enhancing the effectiveness of public health measures.

Hepatitis C virus transmission among people who inject drugs in the Middle East and North Africa: mathematical modeling analyses of incidence and intervention impact

Background

The Middle East and North Africa (MENA) region is the most affected by hepatitis C virus (HCV) infection globally. This study aimed to estimate HCV incidence among people who inject drugs (PWID) in MENA and evaluate the impact of interventions.

Methods

A mathematical model was extended and applied to 13 countries with at least one data point on the population size of PWID and HCV antibody prevalence among PWID, generating estimates for the period 2024-2030. The model was calibrated using multiple datasets, primarily derived from systematic reviews and meta-analyses. Multivariable uncertainty analyses were conducted.

Findings

Incidence rate among PWID in the 13 countries combined was 10.4 per 100 person-years (95% UI: 8.0-14.1), with an estimated 42,364 new infections annually (95% UI: 27,990-57,540), accounting for 16.9% (95% UI: 8.3-28.2) of all cases in these countries. These figures varied widely across countries. A 75% reduction in needle/syringe sharing decreased viremic chronic infection prevalence by 14.2% (95% UI: 11.3-17.1), incidence rate by 33.8% (95% UI: 30.2-40.5), and annual new infections by 24.4% (95% UI: 17.7-30.1). A 10% reduction in PWID numbers and a 20% reduction in injection frequency decreased chronic infection prevalence by 1.7% (95% UI: 1.4-2.5), incidence rate by 4.2% (95% UI: 3.9-4.4), and annual new infections by 11.1% (95% UI: 10.9-11.9). Achieving 75% direct-acting antiviral treatment coverage by 2030 decreased chronic infection prevalence by 65.3% (95% UI: 64.8-65.8), incidence rate by 34.5% (95% UI: 29.6-40.3), and annual new infections by 25.3% (95% UI: 19.9-29.3). Combinations of interventions reduced these epidemiologic outcomes by up to 80%.

Interpretation

MENA experiences considerable HCV incidence among PWID. While the interventions showed potential, only large-scale or multi-intervention strategies can achieve meaningful reductions in HCV transmission.

Funding

This publication was made possible by NPRP grant number 12S-0216-190,094 from the Qatar National Research Fund (a member of Qatar Foundation). The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions, or policies of World Health Organization.

Hepatitis C risk score as a tool to identify individuals with HCV infection: a demonstration and cross-sectional epidemiological study in Egypt

OBJECTIVES

Hepatitis C virus (HCV) infection poses a global health challenge. By the end of 2021, the WHO estimated that less than a quarter of global HCV infections had been diagnosed. There is a need for a public health tool that can facilitate the identification of people with HCV infection and link them to testing and treatment, and that can be customised for each country.

METHODS

We derived and validated a risk score to identify people with HCV in Egypt and demonstrated its utility. Using data from the 2008 and 2014 Egypt Demographic and Health Surveys, two risk scores were constructed through multivariable logistic regression analysis. A range of diagnostic metrics was then calculated to evaluate the performance of these scores.

RESULTS

The 2008 and 2014 risk scores exhibited similar dependencies on sex, age and type of place of residence. Both risk scores demonstrated high and similar areas under the curve of 0.77 (95% CI: 0.76 to 0.78) and 0.78 (95% CI: 0.77 to 0.80), respectively. For the 2008 risk score, sensitivity was 73.7% (95% CI: 71.5% to 75.9%), specificity was 68.5% (95% CI: 67.5% to 69.4%), positive predictive value (PPV) was 27.8% (95% CI: 26.4% to 29.2%) and negative predictive value (NPV) was 94.1% (95% CI: 93.5% to 94.6%). For the 2014 risk score, sensitivity was 64.0% (95% CI: 61.5% to 66.6%), specificity was 78.2% (95% CI: 77.5% to 78.9%), PPV was 22.2% (95% CI: 20.9% to 23.5%) and NPV was 95.7% (95% CI: 95.4% to 96.1%). Each score was validated by applying it to a different survey database than the one used to derive it.

CONCLUSIONS

Implementation of HCV risk scores is an effective strategy to identify carriers of HCV infection and to link them to testing and treatment at low cost to national programmes.

Research progress of traditional Chinese medicine in improving hepatic fibrosis based on inhibiting pathological angiogenesis

Hepatic fibrosis is the formation of scar tissue in the liver. This scar tissue replaces healthy liver tissue and can lead to liver dysfunction and failure if left untreated. It is usually caused by chronic liver disease, such as hepatitis B or C, alcohol abuse, or non-alcoholic fatty liver disease. Pathological angiogenesis plays a crucial role in the development of hepatic fibrosis by promoting the growth of new blood vessels in the liver. These new vessels increase blood flow to the damaged areas of the liver, which triggers the activation of hepatic stellate cells (HSCs). HSCs are responsible for producing excess collagen and other extracellular matrix proteins that contribute to the development of fibrosis. Pathological angiogenesis plays a crucial role in the development of hepatic fibrosis by promoting the growth of new blood vessels in the liver. These new vessels increase blood flow to the damaged areas of the liver, which triggers the activation of HSCs. HSCs are responsible for producing excess collagen and other extracellular matrix proteins that contribute to the development of fibrosis. Traditional Chinese medicine (TCM) has been found to target pathological angiogenesis, thereby providing a potential treatment option for hepatic fibrosis. Several studies have demonstrated that TCM exhibits anti-angiogenic effects by inhibiting the production of pro-angiogenic factors, such as vascular endothelial growth factor and angiopoietin-2, and by reducing the proliferation of endothelial cells. Reviewing and highlighting the unique TCM recognition of treating hepatic fibrosis by targeting pathological angiogenesis may shed light on future hepatic fibrosis research.

Patterns and trends of hepatitis C virus infection in Jordan: an observational study

Background

Hepatitis C virus (HCV) infection levels in Jordan remain uncertain. No HCV national population-based survey has ever been conducted in the country. To meet the World Health Organization's target of reducing HCV incidence to ≤5 per 100,000 people per year by 2030, it is essential to determine the infection levels, identify affected individuals and populations, and provide appropriate treatment using direct-acting antivirals to individuals carrying the virus.

Methods

The study utilized the HCV testing database of 28,798 attendees of Biolab Diagnostic Laboratories in Jordan, covering the period from January 19, 2010, to May 26, 2023. Cross-sectional and cohort study analyses were conducted, including estimating HCV antibody (Ab) prevalence, examining associations with HCV Ab positivity, determining the HCV viremic rate, and estimating HCV incidence rate using a retrospective cohort study design.

Results

A total of 27,591 individuals, with a median age of 31.3 and 52.9% being females, underwent HCV Ab testing, while 1,450 individuals, with a median age of 42.2 and 32.8% being females, underwent HCV RNA PCR testing. The study sample HCV Ab prevalence was 4.0% (95% CI: 3.7-4.2%). After applying probability weights, the weighted HCV Ab prevalence was 5.8% (95% CI: 4.6-7.3%). Age was strongly associated with HCV Ab positivity, particularly among individuals aged 50 years or older, who had 10-fold higher odds of being HCV Ab positive compared to those aged 10-19 years. Males had 2.41-fold higher odds of testing positive for HCV Ab compared to females. The HCV viremic rate was 54.1% (95% CI: 43.0-65.0%). The cumulative incidence of HCV infection, after 5 years of follow-up, was estimated to be 0.41% (95% CI: 0.17-0.99%). The HCV incidence rate was calculated at 1.19 per 1,000 person-years (95% CI, 0.50-2.87).

Conclusion

Prevalence and incidence of HCV infection were substantial, estimated at ~5% and 1 per 1,000 person-years, respectively, and highlighting the presence of core groups actively engaged in the virus' acquisition and transmission. The high observed viremic rate indicates the need for expanding HCV treatment efforts to effectively control HCV transmission in Jordan. Utilizing quality diagnostic laboratories and innovative testing strategies is key to identifying infection carriers and facilitating linkage to treatment and care.

Treatment as prevention for hepatitis C virus in the Middle East and North Africa: a modeling study

Background

Direct-acting antivirals opened an opportunity for eliminating hepatitis C virus (HCV) infection in the Middle East and North Africa (MENA), the region most affected by HCV infection. Impact of HCV treatment as prevention (HCV-TasP) was investigated in 19 MENA countries.

Methods

An age-structured mathematical model was used to assess program impact using epidemiologic and programming measures. The model was fitted to a database of systematically gathered HCV antibody prevalence data. Two main scenarios were investigated for the treatment roll-out to achieve (i) 80% reduction in HCV incidence by 2030, and (ii) incidence rate < 1 per 100,000 person-years by 2030.

Results

In the target-80%-incidence-reduction scenario, number of treatments administrated by 2030 ranged from 2,610 in Lebanon to 180,416 in Sudan with a median of 53,079, and treatment coverage ranged between 40.2 and 78.4% with a median of 60.4%. By 2030, prevalence of chronic infection ranged between 0.0 and 0.3% with a median of 0.1%, and incidence rate, per 100,000 person-years, ranged between 0.9 and 16.3 with a median of 3.2. Program-attributed reduction in incidence rate ranged between 47.8 and 81.9% with a median of 68.5%, and number of averted infections ranged between 401 and 68,499 with a median of 8,703. Number of treatments needed to prevent one new infection ranged from 1.7 in Oman to 25.9 in Tunisia with a median of 6.5. In the target incidence rate  < 1 per 100,000 person-years scenario, number of treatments administrated by 2030 ranged from 3,470 in Lebanon to 211,912 in Sudan with a median of 54,479, and treatment coverage ranged between 55.5 and 95.9% with a median of 87.5%. By 2030, prevalence of chronic infection was less than 0.1%, and incidence rate, per 100,000 person-years, reached less than 1. Program-attributed reduction in incidence rate ranged between 61.0 and 97.5% with a median of 90.7%, and number of averted infections ranged between 559 and 104,315 with a median of 12,158. Number of treatments needed to prevent one new infection ranged from 1.3 in Oman to 25.9 in Tunisia with a median of 5.5.

Conclusion

HCV-TasP is an effective and indispensable prevention intervention to control MENA's HCV epidemic and to achieve elimination by 2030.

Sub-genotypes of hepatitis C virus in the Middle East and North Africa: Patterns of distribution and temporal changes

Infection with the hepatitis C virus (HCV) remains a considerable public health concern in the Middle East and North Africa (MENA). The objectives of this study were to analyze the HCV genotype (GT) and sub-genotype (SGT) distribution in the MENA region and to assess the temporal change in the number of sequences within the MENA region. All HCV molecular sequences collected in the MENA region had been retrieved from GenBank as of 1 August 2022. The number of HCV sequences retrieved was 6740 representing sequences from a total of 17 MENA countries with a majority from Iran (n = 1969, 29.2%), Egypt (n = 1591, 23.6%), Tunisia (n = 1305, 19.4%) and Saudi Arabia (n = 1085, 16.1%). The determination of GT/SGT was based on the NCBI genotyping and Blast tool. Genotype 1 (GT1) dominated infections in the MENA (n = 2777, 41.2%), followed by GT4 (n = 2566, 39.0%). Additionally, SGT4a (1515/6393, 23.7%) was the most common SGT in the MENA, and SGT4a was dominant in Egypt and Saudi Arabia, followed by SGT1b (n = 1308, 20.5%), which was dominant in Morocco and Tunisia, while SGT1a (n = 1275, 19.9%) was common in Iran, Iraq and Palestine. Furthermore, significant temporal increase in the number of HCV MENA sequences was observed. On the SGT level, specific patterns of HCV genetic diversity were seen in the MENA region, with the most common SGT being 4a, in addition to increasing the availability of HCV sequences in the MENA region.