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Hepatitis C virus viremic rate in the Middle East and North Africa: Systematic synthesis, meta-analyses, and meta-regressions

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  • Manale Harfouche
  • Hiam Chemaitelly
  • Silva P Kouyoumjian
  • Sarwat Mahmud
  • Karima Chaabna
  • Zaina Al-Kanaani
  • Laith J Abu-Raddad

Abstract

Objectives: To estimate hepatitis C virus (HCV) viremic rate, defined as the proportion of HCV chronically infected individuals out of all ever infected individuals, in the Middle East and North Africa (MENA). Methods: Sources of data were systematically-gathered and standardized databases of the MENA HCV Epidemiology Synthesis Project. Meta-analyses were conducted using DerSimonian-Laird random-effects models to determine pooled HCV viremic rate by risk population or subpopulation, country/subregion, sex, and study sampling method. Random-effects meta-regressions were conducted to identify predictors of higher viremic rate. Results: Analyses were conducted on 178 measures for HCV viremic rate among 19,593 HCV antibody positive individuals. In the MENA region, the overall pooled mean viremic rate was 67.6% (95% CI: 64.9–70.3%). Across risk populations, the pooled mean rate ranged between 57.4% (95% CI: 49.4–65.2%) in people who inject drugs, and 75.5% (95% CI: 61.0–87.6%) in populations with liver-related conditions. Across countries/subregions, the pooled mean rate ranged between 62.1% (95% CI: 50.0–72.7%) and 70.4% (95% CI: 65.5–75.1%). Similar pooled estimates were further observed by risk subpopulation, sex, and sampling method. None of the hypothesized population-level predictors of higher viremic rate were statistically significant. Conclusions: Two-thirds of HCV antibody positive individuals in MENA are chronically infected. Though there is extensive variation in study-specific measures of HCV viremic rate, pooled mean estimates are similar regardless of risk population or subpopulation, country/subregion, HCV antibody prevalence in the background population, or sex. HCV viremic rate is a useful indicator to track the progress in (and coverage of) HCV treatment programs towards the set target of HCV elimination by 2030.

Suggested Citation

  • Manale Harfouche & Hiam Chemaitelly & Silva P Kouyoumjian & Sarwat Mahmud & Karima Chaabna & Zaina Al-Kanaani & Laith J Abu-Raddad, 2017. "Hepatitis C virus viremic rate in the Middle East and North Africa: Systematic synthesis, meta-analyses, and meta-regressions," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-22, October.
    • Handle: RePEc:plo:pone00:0187177
    DOI: 10.1371/journal.pone.0187177
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