Importance and Contribution of Community, Social, and Healthcare Risk Factors for Hepatitis C Infection in Pakistan

Abstract

Pakistan has a high prevalence of hepatitis C virus (HCV) infection, estimated at 4.9% (2,290/46,843) in the 2007 national HCV seroprevalence survey. We used data from this survey to assess the importance of risk factor associations with HCV prevalence in Pakistan. Exposures were grouped as community (going to the barbers, sharing smoking equipment, having an ear/nose piercing, tattoo, or acupuncture), healthcare (ever having hemodialysis, blood transfusion, or ≥ 5 injections in the last year), demographic (marital status and age), and socio-economic (illiterate or laborer). We used mutually adjusted multivariable regression analysis, stratified by sex, to determine associations with HCV infection, their population attributable fraction, and how risk of infection accumulates with multiple exposures. Strength of associations was assessed using adjusted odds ratios (aOR). Community [aOR females 1.5 (95% confidence interval [CI]: 1.2, 1.8); males 1.2 (1.1, 1.4)] and healthcare [females 1.4 (1.2, 1.6); males 1.2 (1.1, 1.4)] exposures, low socio-economic status [females 1.6 (1.3, 1.80); males 1.3 (1.2, 1.5)], and marriage [females 1.5 (1.2, 1.9); males 1.4 (1.1, 1.8)] were associated with increased HCV infection. Among married women, the number of children was associated with an increase in HCV infection; linear trend aOR per child 1.06 (1.01, 1.11). Fewer infections could be attributed to healthcare exposures (females 13%; males 6%) than to community exposures (females 25%; males 9%). Prevalence increased from 3% to 10% when cumulative exposures increased from 1 to ≥ 4 [aOR per additional exposure for females 1.5 (1.4, 1.6); males 1.2 (1.2, 1.3)]. A combination of community, healthcare, and other factors appear to drive the Pakistan HCV epidemic, highlighting the need for a comprehensive array of prevention strategies.

The cost of eliminating hepatitis C in Pakistan

“…Indeed, unsafe therapeutic injections and nosocomial transmission are bigger risk factors for hepatitis C transmission than intravenous drug use. 7,8 An example of this trend was the 2019 outbreak of HIV amongst children in Larkana, Pakistan that was traced back to negligent practices at the health-care centres. 9 This example also challenges the underlying assumption that the largest at-risk group consists of adults older than 30 years.…”

Direct-acting antiviral agents in the treatment of chronic Hepatitis C – Real-life experience from clinical practices in Pakistan

“…injections and blood transfusion in health care professionals (27-42.3%) and in the general population (7.8-68%), community-based activities i.e. ear and nose piercing, barbering, and injecting drug use (4,7,8).…”

Clustering of hepatitis C virus antibody positivity within households and communities in Punjab, India

“…One study found intraspousal HCV transmission more common than other intrafamilial transmission [29]. The association found between low S-ES and anti-HCV positivity has been demonstrated previously, including in Thailand [30], the Netherlands [31] and Pakistan [32, 33]. Utilizing advanced molecular diagnostics, such as deep-gene sequencing, could better define transmission patterns within households, elucidating risks and guiding prevention efforts.…”