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

To better understand hepatitis C virus (HCV) epidemiology in Punjab state, India, we estimated the distribution of HCV antibody positivity (anti-HCV+) using a 2013-2014 HCV household seroprevalence-survey. Household anti-HCV+ clustering was investigated a) by individual-level multivariable logistic regression, and b) comparing the observed frequency of households with multiple anti-HCV+ persons against the expected, simulated frequency assuming anti-HCV+ persons are randomly distributed. Village/ward level clustering was investigated similarly. We estimated household-level associations between exposures and the number of anti-HCV+ members in a household (N=1,593 households) using multivariable ordered logistic regression. Anti-HCV+ prevalence was 3.6% (95% confidence interval 3.0%-4.2%). Individual-level regression (N=5,543 participants) found an odds ratio of 3.19 (2.25-4.50) for someone being anti-HCV+ if another household member was anti-HCV+. Thirty households surveyed had ≥2 anti-HCV+ members, whereas 0/1000 (P<.001) simulations had ≥30 such households. Excess village-level clustering was evident: 10 villages had ≥6 anti-HCV+ members, occurring in 31/1000 simulations (P=.031). The household-level model indicated the number of household members, living in southern Punjab, lower socio-economic score, and a higher proportion having ever used opium/bhuki were associated with a household’s number of anti-HCV+ members. Anti-HCV+ clusters within households and villages in Punjab, India. These data should be used to inform screening efforts.