Department of Research and Development, Biolab Diagnostic Laboratories, Amman, Jordan.
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
Front Public Health. 2023 Dec 7;11:1280427. doi: 10.3389/fpubh.2023.1280427. eCollection 2023.
Hepatitis C virus (HCV) infection levels in Jordan remain uncertain. No HCV national population-based survey has ever been conducted in the country. To meet the World Health Organization's target of reducing HCV incidence to ≤5 per 100,000 people per year by 2030, it is essential to determine the infection levels, identify affected individuals and populations, and provide appropriate treatment using direct-acting antivirals to individuals carrying the virus.
The study utilized the HCV testing database of 28,798 attendees of Biolab Diagnostic Laboratories in Jordan, covering the period from January 19, 2010, to May 26, 2023. Cross-sectional and cohort study analyses were conducted, including estimating HCV antibody (Ab) prevalence, examining associations with HCV Ab positivity, determining the HCV viremic rate, and estimating HCV incidence rate using a retrospective cohort study design.
A total of 27,591 individuals, with a median age of 31.3 and 52.9% being females, underwent HCV Ab testing, while 1,450 individuals, with a median age of 42.2 and 32.8% being females, underwent HCV RNA PCR testing. The study sample HCV Ab prevalence was 4.0% (95% CI: 3.7-4.2%). After applying probability weights, the weighted HCV Ab prevalence was 5.8% (95% CI: 4.6-7.3%). Age was strongly associated with HCV Ab positivity, particularly among individuals aged 50 years or older, who had 10-fold higher odds of being HCV Ab positive compared to those aged 10-19 years. Males had 2.41-fold higher odds of testing positive for HCV Ab compared to females. The HCV viremic rate was 54.1% (95% CI: 43.0-65.0%). The cumulative incidence of HCV infection, after 5 years of follow-up, was estimated to be 0.41% (95% CI: 0.17-0.99%). The HCV incidence rate was calculated at 1.19 per 1,000 person-years (95% CI, 0.50-2.87).
Prevalence and incidence of HCV infection were substantial, estimated at ~5% and 1 per 1,000 person-years, respectively, and highlighting the presence of core groups actively engaged in the virus' acquisition and transmission. The high observed viremic rate indicates the need for expanding HCV treatment efforts to effectively control HCV transmission in Jordan. Utilizing quality diagnostic laboratories and innovative testing strategies is key to identifying infection carriers and facilitating linkage to treatment and care.
约旦的丙型肝炎病毒 (HCV) 感染水平仍不确定。该国从未进行过全国性的 HCV 人群调查。为了实现世界卫生组织到 2030 年将 HCV 发病率降低至每年每 10 万人 5 例以下的目标，有必要确定感染水平，确定受影响的个人和人群，并使用直接作用抗病毒药物为携带病毒的个人提供适当的治疗。
本研究利用了 2010 年 1 月 19 日至 2023 年 5 月 26 日期间在约旦 Biolab 诊断实验室就诊的 28798 名参与者的 HCV 检测数据库。进行了横断面和队列研究分析，包括估计 HCV 抗体 (Ab) 流行率，检查与 HCV Ab 阳性的关联，确定 HCV 病毒血症率，并使用回顾性队列研究设计估计 HCV 发病率。
共有 27591 人接受了 HCV Ab 检测，中位年龄为 31.3 岁，52.9%为女性，1450 人接受了 HCV RNA PCR 检测，中位年龄为 42.2 岁，32.8%为女性。研究样本 HCV Ab 流行率为 4.0%（95%CI：3.7-4.2%）。应用概率权重后，加权 HCV Ab 流行率为 5.8%（95%CI：4.6-7.3%）。年龄与 HCV Ab 阳性密切相关，尤其是 50 岁或以上的人群，他们感染 HCV Ab 的几率是 10-19 岁人群的 10 倍。男性感染 HCV Ab 的几率是女性的 2.41 倍。HCV 病毒血症率为 54.1%（95%CI：43.0-65.0%）。在 5 年的随访后，估计 HCV 感染的累积发病率为 0.41%（95%CI：0.17-0.99%）。HCV 发病率为每年每 1000 人 1.19 例（95%CI，0.50-2.87）。
HCV 感染的流行率和发病率均相当高，分别估计为~5%和 1 例/1000 人年，这突出了核心人群积极参与了病毒的获得和传播。高观察到的病毒血症率表明需要扩大 HCV 治疗工作，以有效控制约旦的 HCV 传播。利用高质量的诊断实验室和创新的检测策略是识别感染携带者并促进与治疗和护理联系的关键。
