Makhoul Monia, Mumtaz Ghina R, Ayoub Houssein H, Jamil Muhammad S, Hermez Joumana G, Alaama Ahmed S, Abu-Raddad Laith J
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, 24144, Qatar.
World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar-Foundation-Education City, Doha, 24144, Qatar.
EClinicalMedicine. 2025 Jan 15;80:103040. doi: 10.1016/j.eclinm.2024.103040. eCollection 2025 Feb.
The Middle East and North Africa (MENA) region is the most affected by hepatitis C virus (HCV) infection globally. This study aimed to estimate HCV incidence among people who inject drugs (PWID) in MENA and evaluate the impact of interventions.
A mathematical model was extended and applied to 13 countries with at least one data point on the population size of PWID and HCV antibody prevalence among PWID, generating estimates for the period 2024-2030. The model was calibrated using multiple datasets, primarily derived from systematic reviews and meta-analyses. Multivariable uncertainty analyses were conducted.
Incidence rate among PWID in the 13 countries combined was 10.4 per 100 person-years (95% UI: 8.0-14.1), with an estimated 42,364 new infections annually (95% UI: 27,990-57,540), accounting for 16.9% (95% UI: 8.3-28.2) of all cases in these countries. These figures varied widely across countries. A 75% reduction in needle/syringe sharing decreased viremic chronic infection prevalence by 14.2% (95% UI: 11.3-17.1), incidence rate by 33.8% (95% UI: 30.2-40.5), and annual new infections by 24.4% (95% UI: 17.7-30.1). A 10% reduction in PWID numbers and a 20% reduction in injection frequency decreased chronic infection prevalence by 1.7% (95% UI: 1.4-2.5), incidence rate by 4.2% (95% UI: 3.9-4.4), and annual new infections by 11.1% (95% UI: 10.9-11.9). Achieving 75% direct-acting antiviral treatment coverage by 2030 decreased chronic infection prevalence by 65.3% (95% UI: 64.8-65.8), incidence rate by 34.5% (95% UI: 29.6-40.3), and annual new infections by 25.3% (95% UI: 19.9-29.3). Combinations of interventions reduced these epidemiologic outcomes by up to 80%.
MENA experiences considerable HCV incidence among PWID. While the interventions showed potential, only large-scale or multi-intervention strategies can achieve meaningful reductions in HCV transmission.
This publication was made possible by NPRP grant number 12S-0216-190,094 from the Qatar National Research Fund (a member of Qatar Foundation). The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions, or policies of World Health Organization.
中东和北非（MENA）地区是全球受丙型肝炎病毒（HCV）感染影响最严重的地区。本研究旨在估计中东和北非地区注射吸毒者（PWID）中的HCV发病率，并评估干预措施的影响。
扩展了一个数学模型，并将其应用于13个国家，这些国家至少有一个关于注射吸毒者人口规模和注射吸毒者中HCV抗体流行率的数据点，生成了2024 - 2030年期间的估计值。该模型使用多个数据集进行校准，这些数据集主要来自系统评价和荟萃分析。进行了多变量不确定性分析。
13个国家的注射吸毒者综合发病率为每100人年10.4例（95%不确定区间：8.0 - 14.1），估计每年有42364例新感染病例（95%不确定区间：27990 - 57540），占这些国家所有病例的16.9%（95%不确定区间：8.3 - 28.2）。这些数字在各国之间差异很大。针头/注射器共用减少75%可使病毒血症慢性感染流行率降低14.2%（95%不确定区间：11.3 - 17.1），发病率降低33.8%（95%不确定区间：30.2 - 40.5），每年新感染病例减少24.4%（95%不确定区间：17.7 - 30.1）。注射吸毒者人数减少10%且注射频率降低20%可使慢性感染流行率降低1.7%（95%不确定区间：1.4 - 2.5），发病率降低4.2%（95%不确定区间：3.9 - 4.4），每年新感染病例减少11.1%（95%不确定区间：10.9 - 11.9）。到2030年实现75%的直接抗病毒治疗覆盖率可使慢性感染流行率降低65.3%（95%不确定区间：64.8 - 65.8），发病率降低34.5%（95%不确定区间：29.6 - 40.3），每年新感染病例减少25.3%（95%不确定区间：19.9 - 29.3）。干预措施的组合可将这些流行病学结果降低多达80%。
中东和北非地区注射吸毒者中HCV发病率相当高。虽然干预措施显示出潜力，但只有大规模或多干预策略才能实现HCV传播的显著减少。
本出版物由卡塔尔国家研究基金（卡塔尔基金会成员）的NPRP资助项目12S - 0216 - 190,094促成。仅作者对本出版物中表达的观点负责，这些观点不一定代表世界卫生组织的观点、决定或政策。
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