The status of hepatitis C virus infection among people who inject drugs in the Middle East and North Africa

Abstract

Background and aims People who inject drugs (PWID) are a key population at high risk of hepatitis C virus (HCV) infection. The aim of this study was to delineate the epidemiology of HCV in PWID in the Middle East and North Africa (MENA). Methods Syntheses of data were conducted on the standardized and systematically assembled databases of the MENA HCV Epidemiology Synthesis Project, 1989–2018. Random‐effects meta‐analyses and meta‐regressions were performed. Meta‐regression variables included country, study site, year of data collection and year of publication [to assess trends in HCV antibody prevalence over time], sample size and sampling methodology. Numbers of chronically infected PWID across MENA were estimated. The Shannon Diversity Index was calculated to assess genotype diversity. Results Based on 118 HCV antibody prevalence measures, the pooled mean prevalence in PWID for all MENA was 49.3% [95% confidence interval (CI) = 44.4–54.1%]. The country‐specific pooled mean ranged from 21.7% (95% CI = 4.9–38.6%) in Tunisia to 94.2% (95% CI = 90.8–96.7%) in Libya. An estimated 221 704 PWID were chronically infected, with the largest numbers found in Iran at 68 526 and in Pakistan at 46 554. There was no statistically significant evidence for a decline in HCV antibody prevalence over time. Genotype diversity was moderate (Shannon Diversity Index of 1.01 out of 1.95; 52.1%). The pooled mean percentage for each HCV genotype was highest in genotype 3 (42.7%) and in genotype 1 (35.9%). Conclusion Half of people who inject drugs in the Middle East and North Africa appear to have ever been infected with hepatitis C virus, but there are large variations in antibody prevalence among countries. In addition to > 200 000 chronically infected current people who inject drugs, there is an unknown number of people who no longer inject drugs who may have acquired hepatitis C virus during past injecting drug use. Harm reduction services must be expanded, and innovative strategies need to be employed to ensure accessibility to hepatitis C virus testing and treatment.

Understanding and Responding to Substance Use and Abuse in the Palestinian Refugee Camps in Lebanon Prior to and During COVID-19 Times

“…Also, while less than 3% of the HIV epidemic in Lebanon is attributed to unsafe injecting of drugs, accurate data is not available regarding levels of injecting, numbers of people who inject drugs (PWID) and their HIV/Hepatitis status in the general community (Larney et al, 2020 ; Ministry of Public Health, 2016 ). While daily injecting rates are estimated to be relatively high in Lebanon (Colledge et al, 2020 ), with PWID having an average age of 29.5 years (Hines et al, 2020 ), closed small networks among Lebanese PWID appear to reduce transmission risks (Mahmud et al, 2020 ). Given the close nature of the refugee camps, this may very well be the case for Palestinian PWID.…”

Key associations for hepatitis C virus genotypes in the Middle East and North Africa

“…The emerging HIV epidemics among PWID in MENA, and specifically in Afghanistan, Iran, and Pakistan, have been linked to overlapping injecting networks across these countries . This may have (partially) contributed to the relatively larger presence of genotype 3 among PWID in these countries.…”

Hepatitis C Virus Infection in Persons Who Inject Drugs in the Middle East and North Africa: Intervention Strategies

“…In areas such as Lebanon and Syria, the HCV prevalence ranged from 40–61% among PWIDs [ 44 ]. A pooled analysis suggests that half of PWIDs in the MENA region have been infected with HCV [ 46 ]. Substance use disorders from alcohol and marijuana are prevalent in the Middle East, but in the MENA region, heroin is the most reported injectable drug [ 16 ].…”