Who to Test for Hepatitis C Virus in the Middle East and North Africa?: Pooled Analyses of 2,500 Prevalence Measures, Including 49 Million Tests

Abstract

Expanding hepatitis C virus (HCV) treatment coverage is challenged by limited testing and diagnosis. This study assessed the risk of exposure, for the Middle East and North Africa, by population, yields of testing, and program efficiency of testing strategies. A standardized and systematically assembled database of 2,542 HCV antibody prevalence studies on 49 million individuals was analyzed. Random effects meta‐analyses were conducted to estimate pooled measures for risk of exposure, risk ratio (RR) of exposure, and yields of testing. Program expansion path curves were calculated to assess program efficiency. Countries clustered into two patterns: generalized versus concentrated epidemics. In generalized epidemics (Egypt and Pakistan) relative to general populations, RR of exposure was 6.8 for people who inject drugs (PWID), 6.7 for populations with liver conditions, and 5.0 for populations with high‐risk health care exposures. In concentrated epidemics (remaining countries), corresponding RRs were 97.2, 45.1, and 22.2, respectively. In generalized epidemics, the number of tests needed to identify a chronic infection was 2.5 for PWID, 2.4 for populations with liver conditions, 2.7 for populations with high‐risk health care exposures, and 14.2 for general populations. In concentrated epidemics, corresponding numbers were 2.8, 8.6, 5.1, and 222.2, respectively. Program expansion path curves demonstrated major gains in program efficiency by targeting specific populations. Risk of exposure varies immensely by population and shows a distinctive hierarchy, particularly in concentrated epidemics. Testing strategies can be much more efficient through population prioritization by risk of exposure. General population testing is not programmatically efficient in concentrated epidemics.

Hepatitis C Virus Infection in Populations With Liver‐Related Diseases in the Middle East and North Africa

“…The presented evidence attests to the immediate need for prioritizing LRD populations in HCV testing and treatment programs. Recent evidence has also highlighted the program efficiency of this prioritization . It is also clear that interventions, such as testing and treatment, have not yet reached sufficient effectiveness, coverage, and reach to impact HCV epidemiology (apart from Egypt).…”

“…Recent evidence has also highlighted the program efficiency of this prioritization. (53,54) It is also clear that interventions, such as testing and treatment, have not yet reached sufficient effectiveness, coverage, and reach to impact HCV epidemiology (apart from Egypt). Without timely and effective interventions, elimination of HCV infection and its disease burden by 2030 will not be possible.…”

Hepatitis C Virus Treatment in Children: A Challenge for Hepatitis C Virus Elimination

“…The study concluded that testing strategies can be much more efficient through population prioritization by risk of exposure. 26 Despite the most recent U.S. Food and Drug Administration (FDA) approval of DAA in children aged 3 years and above (September 2019) and approval for ages 12 years and above since April 2017, access to treatment is still a major concern driven by the prohibitive prices of DAA in some countries and the lack of policies and strategies addressing linkage to care and elimination in the pediatric population. Adolescents also face particular challenges in terms of access to and quality of care, as they have special needs (including for confidentiality) and may not be reached by mechanisms aimed at children and adults.…”

General Introduction to Volume 1 Emergent and Reemergent Viruses: Modern Important Issues

“…They multiply and produce viremia in the vertebrates, multiply in the tissues of arthropods, and are passed on to new vertebrates by the bites of arthropods after a period of extrinsic incubation. Research on emerging infectious diseases needs to be identified as a priority in Africa (Petersen et al, 2019;Chemaitelly et al, 2019).…”