Hepatitis C virus seroprevalence, testing, and treatment capacity in public health facilities in Ghana, 2016–2021; A multi-centre cross-sectional study

Abstract

The current burden of Hepatitis C virus infection and the availability of HCV-related services in Ghana are not well described. Previous estimates on HCV seroprevalence in the country are outdated. This study investigated the HCV seroprevalence and testing and treatment capacity in Ghana. A multi-centre cross-sectional study was conducted in which laboratory and blood bank registers from 17 public healthcare institutions in Ghana were reviewed. A survey on cost and availability of HCV-related testing and treatment was also performed. Crude and pooled estimates of HCV seroprevalence, frequency and median cost of available diagnostic tests and medicines were described. The crude HCV seroprevalence was 2.62% (95% CI 2.53–2.72) and the pooled estimate was 4.58% (95% CI 4.06–5.11) among 103,609 persons tested in laboratories. Age (OR 1.02 95% CI 1.01–1.02) and male sex (OR 1.26 95% CI 1.08–1.48) were predictors of a positive anti-HCV RDT test. Northern administrative regions in Ghana had the highest HCV seroprevalence ranging from 8.3–14.4%. Among 55, 458 potential blood donors, crude HCV seroprevalence was 3.57% (95% CI 3.42–3.72). Testing was through Rapid Diagnostic Test (RDT) kits in most facilities, and only 2 of 17 centres were performing HCV RNA testing. The median cost of an anti-HCV RDT test was $0.97 (0–1.61) and $3.23 (1.61–7.58) for persons with and without government health insurance respectively. The median cost of a 12-week course of the pan-genotypic direct-acting antiviral therapy sofosbuvir-daclatasvir was $887.70. In conclusion, there are significant regional differences in HCV burden across Ghana. Limited access to and cost of HCV RNA and DAA therapy hinders testing and treatment capability, and consequently HCV elimination efforts. A national HCV program supported with a sustainable financing plan is required to accelerate HCV elimination in Ghana.

HBV and HCV prevalence and treatment eligibility assessment at a primary health facility in Ghana

“…According to the Polaris Observatory Network, there are currently an estimated 440,000 people living with chronic HCV infection in Ghana, 9% of whom have been diagnosed with less than 1% treated annually. Previous systematic review reported HCV prevalence of 3% in Ghana with a recent nationwide auditing of hospital records estimating the prevalence at 4.6% (Agyeman et al, 2016; Nartey et al, 2023). The proportion from our study with HCV seropositive of 1.85% was less than these estimates but closer to the prevalence of 2.7% reported by a study undertaken previously in Cape Coast, the locale for our study (Tetteh et al, 2020).…”

“…Because the HCV RNA determination was not undertaken in this study, we were unable to determine the proportion of the HCV positive individuals who would have needed treatment. The cost of viral load estimation in Ghana is high, with ancillary tests including HCV genotyping and liver fibrosis status (using FIB-4, APRI, liver elastography and liver biopsy) adding up additional cost to the patients (Nartey et al, 2023). The introduction of the curative DAAs for HCV treatment makes it imperative that population screening ought to be scaled up especially among high-risk groups, including incarcerated individuals, people who inject drugs and children born to mothers with HCV.…”

Prevalence and risk factors of Hepatitis C virus infection in the Upper East Region of Ghana; a community-based cross-sectional study

“…A total of 1,769 individuals were included in the study. Using Cochran’s formula [ 16 ] with a 95% confidence level and an estimated proportion of 14.4% based on previously reported seroprevalence [ 10 ], the minimum sample size required was 190. Participants were consented based on convenience sampling, with screening offered to inhabitants of the nine communities visited as part of World Hepatitis Day 2022—related activities in the district.…”

“…In Ghana, the prevalence of HCV antibody was reported at 3.0% in a systematic review comprising hospital-based and limited community-based studies in 2016 [ 9 ]. Furthermore, hospital-based data from Ghana demonstrated a crude anti-HCV prevalence of 2.6% [ 10 ], and HCV is associated with 6.4% of Hepatocellular Carcinoma (HCC) [ 11 ] cases and 7% of liver-related deaths [ 12 ]. Previous studies on HCV in Ghana have primarily relied on hospital-based data, which may limit our ability to determine prevalence in the general population, therefore there is a need for community-based studies to better characterize the burden of infection.…”

“…Furthermore, there is little evidence on the viremia or chronic HCV prevalence in Ghana from population-based studies, with previous estimates based on modeled data [ 4 ]. Moreover, where earlier studies have demonstrated high seroprevalence regions of HCV within the north of Ghana [ 10 ], little is known about the risk factors associated with HCV in these regions, where there are different socio-cultural norms, high poverty rates, less access to health care and low educational levels compared with southern Ghana [ 13 , 14 ].…”