The burden of hepatitis C virus infection in Punjab, India: A population-based serosurvey

Abstract

IntroductionHepatitis C virus (HCV) infection prevalence is believed to be elevated in Punjab, India; however, state-wide prevalence data are not available. An understanding of HCV prevalence, risk factors and genotype distribution can be used to plan control measures in Punjab.MethodsA cross-sectional, state-wide, population-based serosurvey using a multi-stage stratified cluster sampling design was conducted October 2013 to April 2014. Children aged ≥5 years and adults were eligible to participate. Demographic and risk behavior data were collected, and serologic specimens were obtained and tested for anti-HCV antibody, HCV Ribonucleic acid (RNA) on anti-HCV positive samples, and HCV genotype. Prevalence estimates and adjusted odds ratios for risk factors were calculated from weighted data and stratified by urban/rural residence.Results5,543 individuals participated in the study with an overall weighted anti-HCV prevalence of 3.6% (95% Confidence Interval [CI]: 3.0%–4.2%) and chronic infection (HCV Ribonucleic acid test positive) of 2.6% (95% CI: 2.0%–3.1%). Anti-HCV was associated with being male (adjusted odds ratio 1.52; 95% CI: 1.08–2.14), living in a rural area (adjusted odds ratio 2.53; 95% CI: 1.62–3.95) and was most strongly associated with those aged 40–49 (adjusted odds ratio 40–49 vs. 19–29-year-olds 3.41; 95% CI: 1.90–6.11). Anti-HCV prevalence increased with each blood transfusion received (adjusted odds ratio 1.36; 95% CI: 1.10–1.68) and decreased with increasing education, (adjusted odds ratio 0.37 for graduate-level vs. primary school/no education; 95% CI: 0.16–0.82). Genotype 3 (58%) was most common among infected individuals.DiscussionThe study findings, including the overall prevalence of chronic HCV infection, associated risk factors and demographic characteristics, and genotype distribution can guide prevention and control efforts, including treatment provision. In addition to high-risk populations, efforts targeting rural areas and adults aged ≥40 would be the most effective for identifying infected individuals.

Clustering of hepatitis C virus antibody positivity within households and communities in Punjab, India

“…There were 5543 eligible participants with available HCV testing results who completed the survey, described previously [12]. Briefly, 62% of the surveyed population lived in rural areas, 54% were women and the median age was 35 years (interquartile range (IQR): 21–50).…”

“…This analysis uses data from a cross-sectional seroprevalence survey conducted in Punjab state, India, 2013–2014, described previously [12]. Briefly, the study aimed to estimate HCV antibody (anti-HCV) and viremia prevalence among Punjab residents aged ⩾5 years.…”

Population network structures, graph theory, algorithms to match subgraphs may lead to better clustering of households and communities in epidemiological studies

“…Information about seroprevalence within various groups in the population is often one of the critical requirements for clustering in epidemiological studies. The article by Trickey et al [1] (on 7 October 2019) applied regression-based approaches and simulations to investigate the clusters of household communities for the presence of hepatitis C virus antibodies primarily from the data available through a population-based seroprevalence survey [2]. I appreciate the article [1] and the methods they adopted in investigating the clusters.…”

“…Even if we assume that the survey data [2] and corresponding weights are as accurate as possible (given general limitations applicable to any large-scale population-based surveys and not specific to their paper), the data collected might not be sufficient to optimally identify the formation of the clusters. Different analytical approaches to the present data may also be very profitably employed.…”

Cost-Effectiveness of Therapeutic Use of Safety-Engineered Syringes in Healthcare Facilities in India

“…The prevalence of chronic HBV infection and chronic HCV infection in India is around 3-4% and < 1%, respectively [16,17]. However, there is a large variation in the burden, with a much higher prevalence of HCV infection reported in Punjab [18]. In terms of HIV, India has the third highest prevalence in the world among adults (aged 15-49 years) [19].…”