Hepatitis C Virus Infection in Indigenous Populations in the United States and Canada

Abstract

American Indian/Alaska Native (AI/AN) and Canadian Indigenous people are disproportionally affected by hepatitis C virus (HCV) infection yet are frequently underrepresented in epidemiologic studies and surveys often used to inform public health efforts. We performed a systematic review of published and unpublished literature and summarized our findings on HCV prevalence in these Indigenous populations. We found a disparity of epidemiologic literature of HCV prevalence among AI/AN in the United States and Indigenous people in Canada. The limited data available, which date from 1995, demonstrate a wide range of HCV prevalence in AI/AN (1.49%-67.60%) and Indigenous populations (2.28%-90.24%). The highest HCV prevalence in both countries was reported in studies that either included or specifically targeted people who inject drugs. Lower prevalence was reported in studies of general Indigenous populations, although in Canada, the lowest prevalence was up to 3-fold higher in Aboriginal people compared with general population estimates. The disparity of available data on HCV prevalence and need for consistent and enhanced HCV surveillance and reporting among Indigenous people are highlighted. HCV affects Indigenous peoples to a greater degree than the general population; thus we recommend tribal and community leaders be engaged in enhanced surveillance efforts and that funds benefitting all Indigenous persons be expanded to help prevent and cover health care expenses to help stop this epidemic.

Keywords: American Indian; Canadian Aboriginal; epidemic; hepatitis C virus; indigenous; prevalence; systematic review.

Figure 1

Four-phase flow diagram showing the systematic review stages based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Summary of excluded records or articles: 37 records did not meet eligibility criteria during the initial screening of titles and abstracts. In the next phase, 14 more records were excluded for which prevalence was not reported or could not be determined using the reported data: 5 did not have sufficient information on sample size; 3 were review articles; 3 used data from the same study, for which the most recent was chosen for inclusion in the review; 1 reported data from persons positive for hepatitis C virus only; 1 reported incidence; 1 was an opinion article and contained no data.

Figure 2

Overall prevalence of HCV antibody (anti-HCV+) among American Indian/Alaska Native people in the United States, 1995–2017. AZ, Arizona; CA, California; CI, confidence interval; HCV, hepatitis C virus.

Figure 3

Prevalence of HCV antibody (anti-HCV+) among American Indian/Alaska Native people who inject drugs in the United States, 1995–2017. CI, confidence interval; HCV, hepatitis C virus.

Figure 4

Overall prevalence of HCV antibody (anti-HCV+) among American Indian/Alaska Native people in Canada, 1995–2017. CI, confidence interval; HCV, hepatitis C virus.

Figure 5

Prevalence of HCV antibody (anti-HCV+) among American Indian/Alaska Native people who inject drugs in Canada, 1995–2017. CI, confidence interval; HCV, hepatitis C virus.