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Mansoor M, de Glanville WA, Alam R, Aslam K, Ahmed M, Isaakidis P, Pasha A. Prevalence and risk factors for hepatitis C virus infection in an informal settlement in Karachi, Pakistan. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002076. [PMID: 37729129 PMCID: PMC10511086 DOI: 10.1371/journal.pgph.0002076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
The burden of hepatitis C virus (HCV) infection in Pakistan is amongst the highest in the world. People living in slums are likely to be at high risk of infection. Here, we describe the results of a cross-sectional survey conducted in March 2022 that aimed to quantify the prevalence of HCV infection in Machar Colony, one of the largest and oldest slum settlements in Karachi. Risk factors for HCV seropositivity were identified using multi-level logistic regression. We recruited 1,303 individuals in a random selection of 441 households from Machar Colony. The survey-adjusted HCV-seroprevalence was 13.5% (95% Confidence Interval (CI) 11.1-15.8) and survey-adjusted viraemic prevalence was 4.1% (95% CI 3.1-5.4) with a viraemic ratio of 32% (95% CI 24.3-40.5). Of 162 seropositive people, 71 (44%) reported receiving previous treatment for chronic hepatitis C. The odds of HCV seropositivity were found to increase with each additional reported therapeutic injection in the past 12 months (OR = 1.07 (95% Credible Interval (CrI) 1.00-1.13)). We found weaker evidence for a positive association between HCV seropositivity and a reported history of receiving a blood transfusion (OR = 1.72 (95% CrI 0.90-3.21)). The seroprevalence was more than double the previously reported seroprevalence in Sindh Province. The overall proportion of seropositive people that were viraemic was lower than expected. This may reflect the long-term impacts of a non-governmental clinic providing free of cost and easily accessible hepatitis C diagnosis and treatment to the population since 2015. Reuse of needles and syringes is likely to be an important driver of HCV transmission in this setting. Future public health interventions should address the expected risks associated with iatrogenic HCV transmission in this community.
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Affiliation(s)
- Munazza Mansoor
- Interactive Research and Development (IRD), Karachi, Pakistan
| | | | - Ridwa Alam
- Interactive Research and Development (IRD), Karachi, Pakistan
| | - Khawar Aslam
- Médecins Sans Frontières (MSF), Brussels, Belgium
| | | | - Petros Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Aneeta Pasha
- Interactive Research and Development (IRD), Karachi, Pakistan
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Rabold EM, Ali H, Fernandez D, Knuth M, Schenkel K, Asghar RJ, Baig MA, Shaikh S, Morgan O. Systematic Review of Reported HIV Outbreaks, Pakistan, 2000-2019. Emerg Infect Dis 2021; 27:1039-1047. [PMID: 33755545 PMCID: PMC8007288 DOI: 10.3201/eid2704.204205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In the absence of robust testing programs, timely and detailed outbreak reporting is essential for HIV control. Unsafe injection practices and injection drug use have been linked to multiple HIV outbreaks in Pakistan since 2003; however, few studies have systematically analyzed the causes of these outbreaks. We conducted a systematic review of published English-language literature indexed in bibliographic databases and search engines and a focused gray literature review to collate and analyze all reported HIV outbreaks in Pakistan during 2000–2019. Of 774 unique publications reviewed, we identified 25 eligible publications describing 7 outbreaks. More than half occurred during 2016–2019. The primary sources of transmission were iatrogenic transmission, affecting children, persons with chronic medical conditions, and the general population (4 outbreaks); injection drug use (2 outbreaks); and a combination of both (1 outbreak). In the absence of robust HIV testing and surveillance in Pakistan, timely and detailed outbreak reporting is important to understand the epidemiology of HIV in the country.
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Affiliation(s)
| | | | - Danielle Fernandez
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E.M. Rabold, H. Ali, D. Fernandez, M. Knuth)
- World Health Organization, Geneva, Switzerland (K. Schenkel, O. Morgan)
- Global Health Strategists and Implementers, Karachi, Pakistan (R.J. Asghar)
- Pakistan Field Epidemiology and Laboratory Training Program, Karachi (M.A. Baig)
- Sindh AIDS Control Program, Larkana, Pakistan (S. Shaikh)
| | - Martha Knuth
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E.M. Rabold, H. Ali, D. Fernandez, M. Knuth)
- World Health Organization, Geneva, Switzerland (K. Schenkel, O. Morgan)
- Global Health Strategists and Implementers, Karachi, Pakistan (R.J. Asghar)
- Pakistan Field Epidemiology and Laboratory Training Program, Karachi (M.A. Baig)
- Sindh AIDS Control Program, Larkana, Pakistan (S. Shaikh)
| | - Karl Schenkel
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E.M. Rabold, H. Ali, D. Fernandez, M. Knuth)
- World Health Organization, Geneva, Switzerland (K. Schenkel, O. Morgan)
- Global Health Strategists and Implementers, Karachi, Pakistan (R.J. Asghar)
- Pakistan Field Epidemiology and Laboratory Training Program, Karachi (M.A. Baig)
- Sindh AIDS Control Program, Larkana, Pakistan (S. Shaikh)
| | - Rana Jawad Asghar
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E.M. Rabold, H. Ali, D. Fernandez, M. Knuth)
- World Health Organization, Geneva, Switzerland (K. Schenkel, O. Morgan)
- Global Health Strategists and Implementers, Karachi, Pakistan (R.J. Asghar)
- Pakistan Field Epidemiology and Laboratory Training Program, Karachi (M.A. Baig)
- Sindh AIDS Control Program, Larkana, Pakistan (S. Shaikh)
| | - Mirza Amir Baig
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E.M. Rabold, H. Ali, D. Fernandez, M. Knuth)
- World Health Organization, Geneva, Switzerland (K. Schenkel, O. Morgan)
- Global Health Strategists and Implementers, Karachi, Pakistan (R.J. Asghar)
- Pakistan Field Epidemiology and Laboratory Training Program, Karachi (M.A. Baig)
- Sindh AIDS Control Program, Larkana, Pakistan (S. Shaikh)
| | - Saqib Shaikh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E.M. Rabold, H. Ali, D. Fernandez, M. Knuth)
- World Health Organization, Geneva, Switzerland (K. Schenkel, O. Morgan)
- Global Health Strategists and Implementers, Karachi, Pakistan (R.J. Asghar)
- Pakistan Field Epidemiology and Laboratory Training Program, Karachi (M.A. Baig)
- Sindh AIDS Control Program, Larkana, Pakistan (S. Shaikh)
| | - Oliver Morgan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E.M. Rabold, H. Ali, D. Fernandez, M. Knuth)
- World Health Organization, Geneva, Switzerland (K. Schenkel, O. Morgan)
- Global Health Strategists and Implementers, Karachi, Pakistan (R.J. Asghar)
- Pakistan Field Epidemiology and Laboratory Training Program, Karachi (M.A. Baig)
- Sindh AIDS Control Program, Larkana, Pakistan (S. Shaikh)
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