Mansoor Munazza, de Glanville William A, Alam Ridwa, Aslam Khawar, Ahmed Mubashir, Isaakidis Petros, Pasha Aneeta
Interactive Research and Development (IRD), Karachi, Pakistan.
Médecins Sans Frontières (MSF), Brussels, Belgium.
PLOS Glob Public Health. 2023 Sep 20;3(9):e0002076. doi: 10.1371/journal.pgph.0002076. eCollection 2023.
The burden of hepatitis C virus (HCV) infection in Pakistan is amongst the highest in the world. People living in slums are likely to be at high risk of infection. Here, we describe the results of a cross-sectional survey conducted in March 2022 that aimed to quantify the prevalence of HCV infection in Machar Colony, one of the largest and oldest slum settlements in Karachi. Risk factors for HCV seropositivity were identified using multi-level logistic regression. We recruited 1,303 individuals in a random selection of 441 households from Machar Colony. The survey-adjusted HCV-seroprevalence was 13.5% (95% Confidence Interval (CI) 11.1-15.8) and survey-adjusted viraemic prevalence was 4.1% (95% CI 3.1-5.4) with a viraemic ratio of 32% (95% CI 24.3-40.5). Of 162 seropositive people, 71 (44%) reported receiving previous treatment for chronic hepatitis C. The odds of HCV seropositivity were found to increase with each additional reported therapeutic injection in the past 12 months (OR = 1.07 (95% Credible Interval (CrI) 1.00-1.13)). We found weaker evidence for a positive association between HCV seropositivity and a reported history of receiving a blood transfusion (OR = 1.72 (95% CrI 0.90-3.21)). The seroprevalence was more than double the previously reported seroprevalence in Sindh Province. The overall proportion of seropositive people that were viraemic was lower than expected. This may reflect the long-term impacts of a non-governmental clinic providing free of cost and easily accessible hepatitis C diagnosis and treatment to the population since 2015. Reuse of needles and syringes is likely to be an important driver of HCV transmission in this setting. Future public health interventions should address the expected risks associated with iatrogenic HCV transmission in this community.
巴基斯坦丙型肝炎病毒（HCV）感染负担位居世界前列。生活在贫民窟的人群感染风险可能很高。在此，我们描述了2022年3月进行的一项横断面调查结果，该调查旨在量化卡拉奇最大且最古老的贫民窟定居点之一马查尔殖民地HCV感染的患病率。使用多水平逻辑回归确定HCV血清阳性的危险因素。我们从马查尔殖民地随机选取441户家庭，招募了1303名个体。经调查调整后的HCV血清流行率为13.5%（95%置信区间（CI）11.1 - 15.8），经调查调整后的病毒血症流行率为4.1%（95%CI 3.1 - 5.4），病毒血症比率为32%（95%CI 24.3 - 40.5）。在162名血清阳性者中，71人（44%）报告曾接受过慢性丙型肝炎治疗。过去12个月内每增加一次报告的治疗性注射，HCV血清阳性的几率就会增加（比值比（OR）= 1.07（95%可信区间（CrI）1.00 - 1.13））。我们发现HCV血清阳性与报告的输血史之间存在正相关的证据较弱（OR = 1.72（95%CrI 0.90 - 3.21））。血清流行率比信德省之前报告的血清流行率高出一倍多。血清阳性且病毒血症患者的总体比例低于预期。这可能反映了自2015年以来一家非政府诊所为该人群提供免费且易于获得的丙型肝炎诊断和治疗所产生的长期影响。在这种情况下，针头和注射器的重复使用很可能是HCV传播的一个重要驱动因素。未来的公共卫生干预措施应应对该社区与医源性HCV传播相关的预期风险。
