Changes in the prevalence of hepatitis B and C viral infectionsin Sindh province, Pakistan:  Findings from two sero-surveys in2007 and 2019

Tesfa Alamneh; Josephine G Walker; Aaron G Lim; Ejaz  Alam; Saeed Hamid; Graham R. Foster; Naheed Choudhry; M Azim Ansari; Huma Qureshi; Peter T Vickerman

doi:10.1111/jvh.13986

Changes in the prevalence of hepatitis B and C viral infectionsin Sindh province, Pakistan: Findings from two sero-surveys in2007 and 2019

Tesfa Alamneh^*, Josephine G Walker, Aaron G Lim, Ejaz Alam, Saeed Hamid, Graham R. Foster, Naheed Choudhry, M Azim Ansari, Huma Qureshi, Peter T Vickerman

^*Corresponding author for this work

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Abstract

Pakistan harbours a large burden of hepatitis B virus (HBV) and hepatitis C virus(HCV) infection. We utilised repeat sero-surveys to assess progress achieved towardshepatitis elimination in Pakistan. Multilevel logistic regression evaluated the changein HBV infection (HBV surface antigen (HBsAg)-positive) prevalence and HCV ex-posure (HCV antibody (HCV-Ab)-positive) prevalence between two sero-surveysfrom 2007 and 2019 for Sindh province and associated risk factors. Adjusted oddsratios (aORs) were estimated and population-attributable fractions (PAF) for modifi-able risk factors for HCV exposure. The 2007 and 2019 surveys included 8855 and6672 individuals. HBsAg prevalence decreased from 2.6% (95% confidence intervals(95% CI): 2.2–2.9) in 2007 to 1.1% (95% CI: 0.8–1.3) in 2019, while HCV-Ab prevalenceincreased from 5.1% (95% CI: 4.6%–5.5%) to 6.2% (95% CI: 5.6%–6.8%). The age andgender-adjusted HBsAg prevalence decreased by 80% (aOR = 0.2, 95% CI: 0.1–0.4)among children and 60% (aOR = 0.4, 95% CI: 0.3–0.6) among adults over 2007–2019,while HCV-Ab prevalence decreased by 60% (aOR = 0.4, 95%CI:0.2–0.7) in childrenand increased by 40% (aOR = 1.4, 95% CI: 1.2–1.7) in adults. HCV-Ab prevalence waslower in adults with secondary (aOR = 0.6, 95% CI: 0.5–0.8) and higher (aOR = 0.5,95%CI:0.3–0.8) education compared to illiterates and higher among adults reportingblood transfusion (aOR = 1.7, 95% CI: 1.2–2.4), family history of hepatitis (aOR = 2.5,95% CI: 1.9–3.3), past year medical injection (aOR = 2.1, 95% CI: 1.6–2.7), being tat-tooed (aOR = 1.4, 95% CI: 1.0–1.9) and shaved by traditional barber (aOR = 1.2, 95%CI: 1.0–1.5). Modifiable risk factors accounted for 45% of HCV exposure, with medicalinjection(s) accounting for 38% (95%CI,25.7–48.4%). Overall HCV has increased over2007–2019 in Sindh province, while HBV prevalence has decreased. Medical injec-tions should be an important focus of prevention activities.

Original language	English
Number of pages	12
Journal	Journal of Viral Hepatitis
DOIs	https://doi.org/10.1111/jvh.13986
Publication status	Published - 26 Jul 2024

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© 2024 The Author(s). Journal of Viral Hepatitis published by John Wiley & Sons Ltd.

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@article{3580e9cef2114745a1cbbbc4209e4979,

title = "Changes in the prevalence of hepatitis B and C viral infectionsin Sindh province, Pakistan: Findings from two sero-surveys in2007 and 2019",

abstract = "Pakistan harbours a large burden of hepatitis B virus (HBV) and hepatitis C virus(HCV) infection. We utilised repeat sero-surveys to assess progress achieved towardshepatitis elimination in Pakistan. Multilevel logistic regression evaluated the changein HBV infection (HBV surface antigen (HBsAg)-positive) prevalence and HCV ex-posure (HCV antibody (HCV-Ab)-positive) prevalence between two sero-surveysfrom 2007 and 2019 for Sindh province and associated risk factors. Adjusted oddsratios (aORs) were estimated and population-attributable fractions (PAF) for modifi-able risk factors for HCV exposure. The 2007 and 2019 surveys included 8855 and6672 individuals. HBsAg prevalence decreased from 2.6% (95% confidence intervals(95% CI): 2.2–2.9) in 2007 to 1.1% (95% CI: 0.8–1.3) in 2019, while HCV-Ab prevalenceincreased from 5.1% (95% CI: 4.6%–5.5%) to 6.2% (95% CI: 5.6%–6.8%). The age andgender-adjusted HBsAg prevalence decreased by 80% (aOR = 0.2, 95% CI: 0.1–0.4)among children and 60% (aOR = 0.4, 95% CI: 0.3–0.6) among adults over 2007–2019,while HCV-Ab prevalence decreased by 60% (aOR = 0.4, 95%CI:0.2–0.7) in childrenand increased by 40% (aOR = 1.4, 95% CI: 1.2–1.7) in adults. HCV-Ab prevalence waslower in adults with secondary (aOR = 0.6, 95% CI: 0.5–0.8) and higher (aOR = 0.5,95%CI:0.3–0.8) education compared to illiterates and higher among adults reportingblood transfusion (aOR = 1.7, 95% CI: 1.2–2.4), family history of hepatitis (aOR = 2.5,95% CI: 1.9–3.3), past year medical injection (aOR = 2.1, 95% CI: 1.6–2.7), being tat-tooed (aOR = 1.4, 95% CI: 1.0–1.9) and shaved by traditional barber (aOR = 1.2, 95%CI: 1.0–1.5). Modifiable risk factors accounted for 45% of HCV exposure, with medicalinjection(s) accounting for 38% (95%CI,25.7–48.4%). Overall HCV has increased over2007–2019 in Sindh province, while HBV prevalence has decreased. Medical injec-tions should be an important focus of prevention activities.",

author = "Tesfa Alamneh and Walker, {Josephine G} and Lim, {Aaron G} and Ejaz Alam and Saeed Hamid and Foster, {Graham R.} and Naheed Choudhry and Ansari, {M Azim} and Huma Qureshi and Vickerman, {Peter T}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). Journal of Viral Hepatitis published by John Wiley & Sons Ltd.",

year = "2024",

month = jul,

day = "26",

doi = "10.1111/jvh.13986",

language = "English",

journal = "Journal of Viral Hepatitis",

issn = "1352-0504",

publisher = "Wiley",

}

TY - JOUR

T1 - Changes in the prevalence of hepatitis B and C viral infectionsin Sindh province, Pakistan

T2 - Findings from two sero-surveys in2007 and 2019

AU - Alamneh, Tesfa

AU - Walker, Josephine G

AU - Lim, Aaron G

AU - Alam, Ejaz

AU - Hamid, Saeed

AU - Foster, Graham R.

AU - Choudhry, Naheed

AU - Ansari, M Azim

AU - Qureshi, Huma

AU - Vickerman, Peter T

PY - 2024/7/26

Y1 - 2024/7/26

N2 - Pakistan harbours a large burden of hepatitis B virus (HBV) and hepatitis C virus(HCV) infection. We utilised repeat sero-surveys to assess progress achieved towardshepatitis elimination in Pakistan. Multilevel logistic regression evaluated the changein HBV infection (HBV surface antigen (HBsAg)-positive) prevalence and HCV ex-posure (HCV antibody (HCV-Ab)-positive) prevalence between two sero-surveysfrom 2007 and 2019 for Sindh province and associated risk factors. Adjusted oddsratios (aORs) were estimated and population-attributable fractions (PAF) for modifi-able risk factors for HCV exposure. The 2007 and 2019 surveys included 8855 and6672 individuals. HBsAg prevalence decreased from 2.6% (95% confidence intervals(95% CI): 2.2–2.9) in 2007 to 1.1% (95% CI: 0.8–1.3) in 2019, while HCV-Ab prevalenceincreased from 5.1% (95% CI: 4.6%–5.5%) to 6.2% (95% CI: 5.6%–6.8%). The age andgender-adjusted HBsAg prevalence decreased by 80% (aOR = 0.2, 95% CI: 0.1–0.4)among children and 60% (aOR = 0.4, 95% CI: 0.3–0.6) among adults over 2007–2019,while HCV-Ab prevalence decreased by 60% (aOR = 0.4, 95%CI:0.2–0.7) in childrenand increased by 40% (aOR = 1.4, 95% CI: 1.2–1.7) in adults. HCV-Ab prevalence waslower in adults with secondary (aOR = 0.6, 95% CI: 0.5–0.8) and higher (aOR = 0.5,95%CI:0.3–0.8) education compared to illiterates and higher among adults reportingblood transfusion (aOR = 1.7, 95% CI: 1.2–2.4), family history of hepatitis (aOR = 2.5,95% CI: 1.9–3.3), past year medical injection (aOR = 2.1, 95% CI: 1.6–2.7), being tat-tooed (aOR = 1.4, 95% CI: 1.0–1.9) and shaved by traditional barber (aOR = 1.2, 95%CI: 1.0–1.5). Modifiable risk factors accounted for 45% of HCV exposure, with medicalinjection(s) accounting for 38% (95%CI,25.7–48.4%). Overall HCV has increased over2007–2019 in Sindh province, while HBV prevalence has decreased. Medical injec-tions should be an important focus of prevention activities.

AB - Pakistan harbours a large burden of hepatitis B virus (HBV) and hepatitis C virus(HCV) infection. We utilised repeat sero-surveys to assess progress achieved towardshepatitis elimination in Pakistan. Multilevel logistic regression evaluated the changein HBV infection (HBV surface antigen (HBsAg)-positive) prevalence and HCV ex-posure (HCV antibody (HCV-Ab)-positive) prevalence between two sero-surveysfrom 2007 and 2019 for Sindh province and associated risk factors. Adjusted oddsratios (aORs) were estimated and population-attributable fractions (PAF) for modifi-able risk factors for HCV exposure. The 2007 and 2019 surveys included 8855 and6672 individuals. HBsAg prevalence decreased from 2.6% (95% confidence intervals(95% CI): 2.2–2.9) in 2007 to 1.1% (95% CI: 0.8–1.3) in 2019, while HCV-Ab prevalenceincreased from 5.1% (95% CI: 4.6%–5.5%) to 6.2% (95% CI: 5.6%–6.8%). The age andgender-adjusted HBsAg prevalence decreased by 80% (aOR = 0.2, 95% CI: 0.1–0.4)among children and 60% (aOR = 0.4, 95% CI: 0.3–0.6) among adults over 2007–2019,while HCV-Ab prevalence decreased by 60% (aOR = 0.4, 95%CI:0.2–0.7) in childrenand increased by 40% (aOR = 1.4, 95% CI: 1.2–1.7) in adults. HCV-Ab prevalence waslower in adults with secondary (aOR = 0.6, 95% CI: 0.5–0.8) and higher (aOR = 0.5,95%CI:0.3–0.8) education compared to illiterates and higher among adults reportingblood transfusion (aOR = 1.7, 95% CI: 1.2–2.4), family history of hepatitis (aOR = 2.5,95% CI: 1.9–3.3), past year medical injection (aOR = 2.1, 95% CI: 1.6–2.7), being tat-tooed (aOR = 1.4, 95% CI: 1.0–1.9) and shaved by traditional barber (aOR = 1.2, 95%CI: 1.0–1.5). Modifiable risk factors accounted for 45% of HCV exposure, with medicalinjection(s) accounting for 38% (95%CI,25.7–48.4%). Overall HCV has increased over2007–2019 in Sindh province, while HBV prevalence has decreased. Medical injec-tions should be an important focus of prevention activities.

U2 - 10.1111/jvh.13986

DO - 10.1111/jvh.13986

M3 - Article (Academic Journal)

C2 - 39056891

SN - 1352-0504

JO - Journal of Viral Hepatitis

JF - Journal of Viral Hepatitis

ER -