Estimating the prevalence of hepatitis C among intravenous drug users in upper middle income countries: A systematic review and meta-analysis

Abstract

Aim This systematic review and meta-analysis characterizes the prevalence of hepatitis C virus (HCV) infection among intravenous drug users (IDUs) in upper middle-income countries. Methods Five databases were searched from 1990–2016 for studies that took place in countries with a GDP per capita of $7,000 to $13,000 USD. The data extraction was performed based on information regarding prevalence, sample size, age of participants, duration of intravenous drug use (IDU), recruitment location, dates of data collection, study design, sampling scheme, type of tests used in identifying antibody reactivity to HCV, and the use of confirmatory tests. The synthesis was performed with a random effects model. The Cochrane statistical Q-test was used to evaluate the statistical heterogeneity of the results. Results The 33 studies included in the analysis correspond to a sample of seven countries and 23,342 observations. The point prevalence value estimates and confidence intervals of the random effects model were 0.729 and 0.644–0.800, respectively for all seven countries, and were greatest for China (0.633; 0.522–0.732) as compared to Brazil (0.396; 0.249–0.564). Prevalence for Montenegro (0.416; 0.237–0.621) and Malaysia (0.475; 0.177–0.792) appear to be intermediate. Mexico (0.960) and Mauritania (0.973) had only one study with the largest prevalence. A clear association was not observed between age or duration of IDU and prevalence of HCV, but the data from some groups may indicate a possible relationship. The measures of heterogeneity (Q and I2) suggest a high level of heterogeneity in studies conducted at the country level and by groups of countries. Conclusions In this systematic review and meta-analysis, we found that the pooled prevalence of HCV was high (0.729) among a group of seven upper middle income countries. However, there was significant variation in the prevalence of HCV observed in China (0.633) and Brazil (0.396).

A systematic review and meta-analysis of the prevalence of hepatitis C virus infection in people who inject drugs in Iran

“…Moreover, the findings of this study showed that the prevalence of HCV in men was higher than that among women, which was consistent with the results of studies performed in India [84] as well as in upper middleincome countries [78]. Men were found to be more Fig.…”

“…These differences in prevalence can be attributed to Fig. 2 The forest plot of the studies included in the present systematic review and meta-analysis differences in health systems, screening methods, and the type of high-risk behaviors of individuals [77,78]. In particular, in developing countries, harm reduction programs such as syringe distribution are not fully implemented [79].…”

Risk factors for hepatitis C infection among adult patients in Kedah state, Malaysia: A case–control study

“…A previous study also found that the prevalence of HCV infection was higher among injection drug users (67.1%) than among non-injection drug users (30.8%) [11]. Among upper middle-income countries, the prevalence of HCV among injection drug users in Malaysia is comparable to prevalence in Montenegro and Brazil, although lower than China [31]. This large population of drug users, combined with the high prevalence of HCV among this group, warrants greater efforts to address this issue.…”

Harm reduction program and hepatitis C prevalence in people who inject drugs (PWID) in Iran: an updated systematic review and cumulative meta-analysis

“…The results showed a high prevalence of HCV Ab among PWID in Iran, which is consistent with a worldwide estimate in this population [ 103 ] and other systematic reviews [ 22 , 38 ], and still lower than the prevalence reported in certain other countries (e.g., Bulgaria, Estonia, and South Africa) [ 104 , 105 ] but higher than in studies conducted in Kuwait (12.3%) [ 106 ], Kingdom of Saudi Arabia (42.7%) [ 107 ], and Brazil (35.6%) [ 108 ]. These differences in the prevalence can be attributed to differences in the health systems, screening methods, and the type of high-risk behaviors of individuals [ 109 , 110 ]. In particular, in the developing countries, the harm reduction programs such as syringe distribution are not fully implemented [ 111 ].…”