Prevalence of Hepatitis C Among Australian Aboriginal and Torres Strait Islander people: A Systematic Review and Meta-Analysis

Abstract

ContextAboriginal and Torres Strait Islanders (Aboriginal) account for approximately 3% of the Australian population. They have the poorest health, economic and social outcomes. Higher notification rates of hepatitis C antibodies (anti-HCV) have been reported among Aboriginal compared with non-Aboriginal people. The identification of Aboriginal people in national surveillance has some weaknesses, with only four of the eight jurisdictions included in national reporting. To address some of these limitations, we aim to estimate the pooled prevalence of anti-HCV among Aboriginal people in Australia.Evidence AcquisitionWe searched the databases: Pubmed, Web of Science and Informit, and the New South Wales and Northern Territory Public Health Bulletins. A study was included if it reported the number of Aboriginal people testing positive for anti-HCV and the number tested for anti-HCV. A meta-analysis by population-group was conducted if three or more studies reported a prevalence estimate. Variables included: author, year of publication, study design, study period, gender (female, male), age, population group (Aboriginal people in prison, Aboriginal people who inject drugs), number testing anti-HCV positive, number tested for anti-HCV and prevalence (%). Due to a long time period, we separated the studies estimating the prevalence anti-HCV among Aboriginal people in prison into two time periods, 1994 - 2004 and 2005 - 2012.ResultsOverall, 15 studies met our inclusion criteria. Among Aboriginal people in prison, the pooled prevalence of anti-HCV was 18.1% (95%CI: 6.6 - 29.7). The pooled prevalence among Aboriginal people in prison was 25.7% (95%CI: 4.1-47.3) in studies published between 1994 - 2004 and 14.5% (95%CI: 1.7 - 27.3) in studies published from 2005 - 2012. The pooled prevalence of anti-HCV was 58.7% (95%CI: 53.9 - 63.5) among Aboriginal people who inject drugs and 2.9% (95%CI: 0.30 - 6.1) among Aboriginal people who did not inject drugs, however there was significant heterogeneity (I2 > 90.0%, P < 0.01). There was significant selection bias in the studies as most included individuals who inject drugs.ConclusionsOur analysis shows that the overall prevalence of anti-HCV was significantly biased towards people who inject drugs; resulting in an over-estimation of anti-HCV prevalence among Aboriginal people. Our review highlights that unsafe injecting is the main transmission route for HCV infection among Aboriginal people in Australia.

Hepatitis C virus notification rates in Australia are highest in socioeconomically disadvantaged areas

“…Despite ATSI populations having a disproportionately high HCV prevalence compared to the general population [ 20 , 21 ], we did not observe a correlation between notification rates and LGAs with large ATSI populations. Possible explanations for this include poor access to services and hence low levels of testing in these areas, or as has been reported anecdotally, the high levels of stigma and shame associated with injecting drugs and HCV in this population could be preventing people from seeking testing and treatment [ 42 ].…”

“…ABS data were used to estimate the population size [ 12 ], the proportion of the population of Aboriginal or Torres Strait Islander (ATSI) descent [ 13 ], the proportion of the population born overseas [ 12 ], Index of Relative Socioeconomic Disadvantage (IRSD) quintiles [ 14 ] and the number of prisons [ 15 – 19 ]. We included the proportion ATSI in the population because this group is known to have disproportionately high HCV prevalence compared to the general population [ 20 , 21 ]. The distribution of this variable is shown in S1 Fig .…”

Disparities in direct acting antivirals uptake in HIV‐hepatitis C co‐infected populations in Canada

“…High rates of IDU, predominantly among young Indigenous people, have recently increased rates of co‐infection significantly in Canada, specifically in the province of Saskatchewan . Similarly in Australia newly diagnosed HCV among Aboriginal people has increased by 38% from 2010 to 2014; in contrast during the same time period, notification rates among non‐Aboriginal people has decreased by 15% . While in Canada there are no system‐level barriers that limit treatment of PWID, our results suggest active PWID, and to a certain extent, past PWID are not accessing DAAs at the same rate as non‐PWID.…”

Elimination of hepatitis C virus infection among PWID: The beginning of a new era of interferon-free DAA therapy

“…Aboriginal PWID are disproportionally affected by HCV in many countries (Graham, Harrod, Iversen, & Simone Hocking, 2016;Lelutiu-Weinberger, et al, 2009;Miller, et al, 2002 1996-2000 to 16% in 2011-2015. While the reason for this increase in proportion of Aboriginal respondents is unclear, this is a concern if it represents an increase in the Aboriginal PWID population as compared to the number of Aboriginal PWID accessing NSP services.…”