Estimation of hepatitis C prevalence in the Punjab province of Pakistan: A retrospective study on general population

Abstract

Background: Hepatitis C virus (HCV) infections are amongst the leading public health concerns in Pakistan with a high disease burden. Despite the availability of effective antiviral treatments in the country the disease burden in general population has not lowered. This could be attributed to the asymptomatic nature of this infection that results in lack of diagnosis until the late symptomatic stage. To better estimate and map HCV infections in the country a population-based analysis is necessary for an effective control of the infection.

Methods: Serologic samples of ~66,000 participants from all major cities of the Punjab province were tested for anti-HCV antibodies. The antibody-based seroprevalence was associated with socio-demographic variables including geographical region, age, gender and sex, and occupation.

Results: Overall serological response to HCV surface antigens was observed in over 17% of the population. Two of the districts were identified with significantly high prevalence in general population. Analysis by occupation showed significantly high prevalence in farmers (over 40%) followed by jobless and retired individuals, laborers and transporters. A significant difference in seroprevalence was observed in different age groups amongst sex and genders (male, female and transgender) with highest response in individuals of over 40 years of age. Moreover, most of the tested IDUs showed positive response for anti-HCV antibody.

Conclusion: This study represents a retrospective analysis of HCV infections in general population of the most populated province of Pakistan to identify socio-demographic groups at higher risk. Two geographical regions, Faisalabad and Okara districts, and an occupational group, farmers, were identified with significantly high HCV seroprevalence. These socio-demographic groups are the potential focused groups for follow-up studies on factors contributing to the high HCV prevalence in these groups towards orchestrating effective prevention, control and treatment.

Fig 1. A summary of HCV seroprevalence in the Punjab province of Pakistan measured in year 2017.

Fig 2. HCV seroprevalence in different geographical regions of the Punjab province in year 2017.

Seroprevalence in percentage of the total tested samples in the respective regions is color-coded. Data from three districts, Chiniot, Hafizabad and Lodhran were combined with neighboring larger districts as mentioned in the legend. Due to unexpected logistical reasons, district Khushab could not be surveyed and therefore no data available from that district. The map was manually populated, using Adobe Illustrator software, with data obtained from descriptive analysis (percentage prevalence).

Fig 3. Sex and gender specific HCV seroprevalence in different age groups in the province of Punjab analyzed in year 2017.

Fig 4. Receiver operator characteristic curve showing the true positive rate (sensitivity) vs. false positive rate (100-specificity) for the discriminant function for reactive and non-reactive HCV.

The area under the curve (blue) i.e. the accuracy of the model is computed to be 0.634.