Harm reduction program and hepatitis C prevalence in people who inject drugs (PWID) in Iran: an updated systematic review and cumulative meta-analysis

Abstract

Background: Prevalence of hepatitis C virus (HCV) infection among people who inject drugs (PWID) in Iran is high. Since 2005, the Iranian government has implemented a harm reduction program to control HCV. We aimed to describe the prevalence of HCV antibody (Ab) in Iranian PWID before and after the implementation of harm reduction with cumulative meta-analysis.

Methods: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the seroprevalence of HCV among PWID. We systematically reviewed the literature to identify eligible studies up to December 2018 in international and national databases. Pooled prevalence and 95% confidence intervals were calculated using Der Simonian and Laird method, taking into account conceptual heterogeneity. Subgroup analyses were performed by harm reduction implementation and studies' characteristics to assess the sources of heterogeneity. We used Cochran-Armitage test for the linear trend of the prevalence of HCV Ab among PWID.

Results: We reviewed 5966 papers and reports and extracted data from 62 eligible records. The pooled HCV Ab prevalence among PWID in Iran was 46.5% (95% confidence interval [95% CI] 41.1-52.0%). Overall, the Cochran-Armitage test for trend indicated a significant decreasing trend of HCV Ab prevalence (P = 0.04). The cumulative meta-analysis showed a slight decline in the prevalence of HCV Ab between the years 2005 and 2018.

Conclusions: The HCV Ab prevalence among PWID in Iran is high, with a considerable geographical variation. The prevalence of HCV Ab among PWID in Iran slightly decreased after 2005 which could be, at least to some extent, related to the implementation of extensive harm reduction programs in the country.

Keywords: HCV; Harm reduction; Intravenous drug use; Iran.

Fig. 1

Flowchart of the search and selection process

Fig. 2

Pooled HCV Ab prevalence in PWID in Iran

Fig. 3

Subgroup analysis of HCV Ab prevalence among PWID in Iran

Fig. 4

Estimated HCV Ab prevalence in PWID by province (1995–2018). Numbers on each province show the sample size of the studies, and the numbers in the parentheses show the number of studies conducted in that province.

Fig. 5

Cumulative meta-analysis of HCV Ab prevalence among PWID in Iran

Fig. 6

Trend of HCV Ab prevalence among PWID in Iran. The Cochran–Armitage test, P value = 0.03

Fig. 7

The funnel’s plot for HCV Ab prevalence among PWID in Iran

Fig. 8

Distribution of studies across time (before 2005 and during and after 2005) by recruitment setting

Fig. 9

Risk of biases across studies according to the criteria

Fig. 10

Forest plots for HCV Ab prevalence in PWID by official period of harm reduction. a Before 2005; b during and after 2005

Fig. 11

Pooled HCV Ab prevalence among PWID by recruitment setting. a Before 2005; b during and after 2005

Fig. 12

Cumulative meta-analysis of HCV Ab prevalence among PWID in Iran by recruitment setting

Fig. 13

Cumulative meta-analysis of HCV Ab prevalence among PWID in DIC and prison settings in Iran by official period of harm reduction

Fig. 14

Trend of HCV Ab prevalence among PWID in Iran by recruitment setting. a Trend of HCV Ab prevalence among PWID in the prison setting, the Cochran–Armitage test, P value = 0.17. b Trend of HCV Ab prevalence among PWID in the hospital/healthcare center setting, the Cochran–Armitage test, P value < 0.001. c Trend of HCV Ab prevalence among PWID in the DIC setting, the Cochran–Armitage test, P value = 0.01