Abstract
Pakistan has the largest national burden of hepatitis C virus (HCV) infections (9.8 million). High
levels of testing and treatment are needed to achieve HCV elimination, but little data exists on this in
Pakistan. A household sero-survey from Sindh province (2019–2020) collected self-reported data
from adults on previous HCV testing and treatment, and undertook HCV-antibody (HCV-Ab) testing
of participants (2988 children (<18) and 3684 adults) and HCV-RNA testing of HCV-Ab positive
individuals. We determined the self-reported HCV cascade-of-care among adults ever eligible for
HCV treatment, defined as either having a past infection (HCV-Ab positive and HCV-RNA negative)
with self-reported treatment history or current infection (HCV-RNA positive). We assessed factors
associated with self-reporting ever being HCV-tested using multi-variable logistic regression. Overall,
10.8% (397/3684) of adults tested HCV Ab-positive in the sero-survey, of which 80.9% (321/397)
had a HCV-RNA test result. Of adults defined as ever treatment eligible (n = 232), 40.9% (95/232)
reported a previous HCV test and 91.2% (87/95) reported testing positive. Of these, HCV treatment
was reported by 69.0% (60/87) and 46.7% (28/60) of treated individuals tested HCV-RNA-negative.
Overall, 25.9% (60/232) of treatment-eligible adults reported being treated. The regression analysis
suggested that males, older adults (>25 years), and adults with a secondary or higher education
level were more likely to have ever been tested for HCV, as were individuals with a family history of
hepatitis, received HBV vaccination or that had various risk factors linked to HCV transmission (e.g.,
blood transfusion, having tattoo/acupuncture, hospitalisation or therapeutic injection (s) history). The
cascade-of-care for HCV needs improving to eliminate HCV in Pakistan, especially among younger
adults, women and people with low education levels.
levels of testing and treatment are needed to achieve HCV elimination, but little data exists on this in
Pakistan. A household sero-survey from Sindh province (2019–2020) collected self-reported data
from adults on previous HCV testing and treatment, and undertook HCV-antibody (HCV-Ab) testing
of participants (2988 children (<18) and 3684 adults) and HCV-RNA testing of HCV-Ab positive
individuals. We determined the self-reported HCV cascade-of-care among adults ever eligible for
HCV treatment, defined as either having a past infection (HCV-Ab positive and HCV-RNA negative)
with self-reported treatment history or current infection (HCV-RNA positive). We assessed factors
associated with self-reporting ever being HCV-tested using multi-variable logistic regression. Overall,
10.8% (397/3684) of adults tested HCV Ab-positive in the sero-survey, of which 80.9% (321/397)
had a HCV-RNA test result. Of adults defined as ever treatment eligible (n = 232), 40.9% (95/232)
reported a previous HCV test and 91.2% (87/95) reported testing positive. Of these, HCV treatment
was reported by 69.0% (60/87) and 46.7% (28/60) of treated individuals tested HCV-RNA-negative.
Overall, 25.9% (60/232) of treatment-eligible adults reported being treated. The regression analysis
suggested that males, older adults (>25 years), and adults with a secondary or higher education
level were more likely to have ever been tested for HCV, as were individuals with a family history of
hepatitis, received HBV vaccination or that had various risk factors linked to HCV transmission (e.g.,
blood transfusion, having tattoo/acupuncture, hospitalisation or therapeutic injection (s) history). The
cascade-of-care for HCV needs improving to eliminate HCV in Pakistan, especially among younger
adults, women and people with low education levels.
| Original language | English |
|---|---|
| Article number | e0004706 |
| Number of pages | 12 |
| Journal | PLOS Global Public Health |
| Volume | 5 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 8 Jul 2025 |
Bibliographical note
Publisher Copyright:© 2025 Alamneh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Research Groups and Themes
- GEM-B
