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Kamga Wouambo R, Panka Tchinda G, Kagoue Simeni LA, Djouela Djoulako PD, Yateu Wouambo CI, Tamko Mella GF, Tchoumi Leuwat EP, Bello D, Fokam J. Anti-hepatitis C antibody carriage and risk of liver impairment in rural-Cameroon: adapting the control of hepatocellular carcinoma for resource-limited settings. BMC Infect Dis 2023; 23:875. [PMID: 38093205 PMCID: PMC10717920 DOI: 10.1186/s12879-023-08880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The Viral hepatitis elimination by 2030 is uncertain in resource-limited settings (RLS), due to high burdens and poor diagnostic coverage. This sounds more challenging for hepatitis C virus (HCV) given that antibody (HCVAb) sero-positivity still lacks wide access to HCV RNA molecular testing. This warrants context-specific strategies for appropriate management of liver impairment in RLS. We herein determine the association between anti-HCV positivity and liver impairment in an African RLS. METHODS A facility-based observational study was conducted from July-August 2021 among individuals attending the "St Monique" Health Center at Ottou, a rural community of Yaounde,Cameroon. Following a consecutive sampling, consenting individuals were tested for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and HIV antibodies (HIVAb) as per the national guidelines. After excluding positive cases for HBsAg and/or HIVAb, liver function tests (ALT/AST) were performed on eligible participants (HBsAg and HIVAb negative) and outcomes were compared according to HCVAb status; with p < 0.05 considered statistically significant. RESULTS Out of 306 eligible participants (negative for HBsAg and HIVAb) enrolled, the mean age was 34.35 ± 3.67 years. 252(82.35%) were female and 129 (42.17%) were single. The overall HCVAb sero-positivity was 15.68%(48/306), with 17.86% (45/252) among women vs. 5.55%(3/54) among men [OR (95%CI) = 3.69(2.11-9.29),p = 0.04]. HCVAb Carriage was greater among participants aged > 50 years compared to younger ones [38.46%(15/39) versus 12.36% (33/267) respectively, OR(95%CI) = 4.43(2.11-9.29), p < 0.000] and in multipartnership [26.67%(12/45)vs.13.79%(36/261) monopartnership, OR (95%CI) = 2.27(1.07-4.80),p = 0.03]. The liver impairment rate (abnormal ALT+AST levels) was 30.39%(93/306), with 40.19%(123/306) of abnormal ALT alone. Moreover, the burden of Liver impairment was significantly with aged> 50 versus younger ones [69.23% (27/39) versus 24.72%(66/267) respectively, p < 0.000). Interestingly, the burden of liver impairment (abnormal AST + ALAT) was significantly higher in HCVAb positive (62.5%, 30/48) versus HCVAb negative (24.42%, 63/258) participants, OR: 3.90 [1.96; 7.79], p = 0.0001. CONCLUSIONS In this rural health facility, HCVAb is highly endemic and the burden of liver impairment is concerning. Interestingly, HCVAb carriage is associated with abnormal liver levels of enzyme (ALT/AST), especially among the elderly populations. Hence, in the absence of nuclei acid testing, ALT/AST are relevant sentinel markers to screen HCVAb carriers who require monitoring/care for HCV-associated hepatocellular carcinoma in RLS.
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Affiliation(s)
- Rodrigue Kamga Wouambo
- Faculty of Science, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon.
| | - Gaelle Panka Tchinda
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon
- Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Luc Aime Kagoue Simeni
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon
- Department of Microbiology, Faculty of Health Science, University of Buea, Buea, Cameroon
| | - Paule Dana Djouela Djoulako
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon
- Faculty of Medicine, Sorbonne University, Paris, France
| | | | - Ghislaine Flore Tamko Mella
- Laboratory of Fundamental Virology, Centre for Research on Emerging and Reemerging Diseases (CREMER), Yaounde, Cameroon
| | | | - Djoda Bello
- Faculty of Science, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Joseph Fokam
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Virology Laboratory, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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Mansoor M, de Glanville WA, Alam R, Aslam K, Ahmed M, Isaakidis P, Pasha A. Prevalence and risk factors for hepatitis C virus infection in an informal settlement in Karachi, Pakistan. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002076. [PMID: 37729129 PMCID: PMC10511086 DOI: 10.1371/journal.pgph.0002076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
The burden of hepatitis C virus (HCV) infection in Pakistan is amongst the highest in the world. People living in slums are likely to be at high risk of infection. Here, we describe the results of a cross-sectional survey conducted in March 2022 that aimed to quantify the prevalence of HCV infection in Machar Colony, one of the largest and oldest slum settlements in Karachi. Risk factors for HCV seropositivity were identified using multi-level logistic regression. We recruited 1,303 individuals in a random selection of 441 households from Machar Colony. The survey-adjusted HCV-seroprevalence was 13.5% (95% Confidence Interval (CI) 11.1-15.8) and survey-adjusted viraemic prevalence was 4.1% (95% CI 3.1-5.4) with a viraemic ratio of 32% (95% CI 24.3-40.5). Of 162 seropositive people, 71 (44%) reported receiving previous treatment for chronic hepatitis C. The odds of HCV seropositivity were found to increase with each additional reported therapeutic injection in the past 12 months (OR = 1.07 (95% Credible Interval (CrI) 1.00-1.13)). We found weaker evidence for a positive association between HCV seropositivity and a reported history of receiving a blood transfusion (OR = 1.72 (95% CrI 0.90-3.21)). The seroprevalence was more than double the previously reported seroprevalence in Sindh Province. The overall proportion of seropositive people that were viraemic was lower than expected. This may reflect the long-term impacts of a non-governmental clinic providing free of cost and easily accessible hepatitis C diagnosis and treatment to the population since 2015. Reuse of needles and syringes is likely to be an important driver of HCV transmission in this setting. Future public health interventions should address the expected risks associated with iatrogenic HCV transmission in this community.
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Affiliation(s)
- Munazza Mansoor
- Interactive Research and Development (IRD), Karachi, Pakistan
| | | | - Ridwa Alam
- Interactive Research and Development (IRD), Karachi, Pakistan
| | - Khawar Aslam
- Médecins Sans Frontières (MSF), Brussels, Belgium
| | | | - Petros Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Aneeta Pasha
- Interactive Research and Development (IRD), Karachi, Pakistan
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De A, Duseja A, Sood A. Who to Screen for Hepatitis C: That is the Question. J Clin Exp Hepatol 2022; 12:1406-1407. [PMID: 36340301 PMCID: PMC9630029 DOI: 10.1016/j.jceh.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Arka De
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
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Malaisamy M, Nagarajan K, Kirti T, Malkeet S, Venkatesan P, Senthilkumar S, Sananthya K, Rajendran K, Kavitha R, Vivekanandan S, Selvavinayagam TS. Economic Evaluation of Implementing a Rapid Point-of-Care Screening Test for the Identification of Hepatitis C Virus under National Viral Hepatitis Control Programme in Tamil Nadu, South India. J Glob Infect Dis 2021; 13:126-132. [PMID: 34703152 PMCID: PMC8491813 DOI: 10.4103/jgid.jgid_394_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/27/2020] [Accepted: 01/30/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Viral hepatitis is a crucial public health problem in India. Hepatitis C virus (HCV) elimination is a national priority and a key strategy has been adopted to strengthen the HCV diagnostics services to ensure early and accurate diagnosis. Methods: To conduct an economic evaluation of implementing a rapid point-of-care screening test for the identification of HCV among the selected key population under the National Viral Hepatitis Control Programme in Tamil Nadu, South India. Economic evaluation of a point-of-care screening test for HCV diagnosis among the key population attending the primary health care centers. A combination of decision tree and Markov model was developed to estimate cost-effectiveness of point-of-care screening test for HCV diagnosis at the primary health care centers. Total costs, quality-adjusted life years (QALYs) of the intervention and comparator, and incremental cost-effectiveness ratio (ICER) were calculated. The model parameter uncertainties which would influence the cost-effectiveness outcome has been evaluated by one-way sensitivity analysis and probabilistic sensitivity analysis. Results: When compared to the tertiary level diagnostic strategy for HCV, the point-of-care screening for selected key population at primary health care level results in a gain of 57 undiscounted QALYs and 38 discounted QALYs, four undiscounted life years and two discounted life years. The negative ICER of the new strategy indicates that it is less expensive and more effective compared with the current HCV diagnosis strategy. Conclusions: The proposed strategy for HCV diagnosis in the selected key population in Tamil Nadu is dominant and cost-saving compared to the current strategy.
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Affiliation(s)
- Muniyandi Malaisamy
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Karikalan Nagarajan
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Tyagi Kirti
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Singh Malkeet
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Prakash Venkatesan
- Department of Public Health and Preventive Medicine, Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, Tamil Nadu, India
| | - S Senthilkumar
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Karthikeyan Sananthya
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Krishnan Rajendran
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Rajsekar Kavitha
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - T S Selvavinayagam
- Department of Public Health and Preventive Medicine, Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, Tamil Nadu, India
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Chahal D, Marquez V, Hussaini T, Kim P, Chung SW, Segedi M, Chartier-Plante S, Scudamore CH, Erb SR, Salh B, Yoshida EM. End stage liver disease etiology & transplantation referral outcomes of major ethnic groups in British Columbia, Canada: A cohort study. Medicine (Baltimore) 2021; 100:e27436. [PMID: 34678872 PMCID: PMC8542110 DOI: 10.1097/md.0000000000027436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/17/2021] [Indexed: 01/15/2023] Open
Abstract
Liver disease etiology and transplantation outcomes may vary by ethnicity. We aimed to determine if disparities exist in our province.We reviewed the provincial database for liver transplant referrals. We stratified cohorts by ethnicity and analyzed disease etiology and outcomes.Four thousand nine hundred sixteen referrals included 220 South Asians, 413 Asians, 235 First Nations (Indigenous), and 2725 Caucasians. Predominant etiologies by ethnicity included alcohol (27.4%) and primary sclerosing cholangitis (PSC) (8.8%) in South Asians, hepatitis B (45.5%) and malignancy (13.9%) in Asians, primary biliary cholangitis (PBC) (33.2%) and autoimmune hepatitis (AIH) (10.8%) in First Nations, and hepatitis C (35.9%) in Caucasians. First Nations had lowest rate of transplantation (30.6%, P = .01) and highest rate of waitlist death (10.6%, P = .03). Median time from referral to transplantation (268 days) did not differ between ethnicities (P = .47). Likelihood of transplantation increased with lower body mass index (BMI) (hazard ratio [HR] 0.99, P = .03), higher model for end stage liver disease (MELD) (HR 1.02, P < .01), or fulminant liver failure (HR 9.47, P < .01). Median time from referral to ineligibility status was 170 days, and shorter time was associated with increased MELD (HR 1.01, P < .01), increased age (HR 1.01, P < .01), fulminant liver failure (HR 2.56, P < .01) or South Asian ethnicity (HR 2.54, P < .01). Competing risks analysis revealed no differences in time to transplant (P = .66) or time to ineligibility (P = .91) but confirmed increased waitlist death for First Nations (P = .04).We have noted emerging trends such as alcohol related liver disease and PSC in South Asians. First Nations have increased autoimmune liver disease, lower transplantation rates and higher waitlist deaths. These data have significance for designing ethnicity specific interventions.
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Affiliation(s)
- Daljeet Chahal
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vladimir Marquez
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trana Hussaini
- Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - Peter Kim
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Stephen W. Chung
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Maja Segedi
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Stephanie Chartier-Plante
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Charles H. Scudamore
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Siegfried R. Erb
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Baljinder Salh
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric M. Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
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Population network structures, graph theory, algorithms to match subgraphs may lead to better clustering of households and communities in epidemiological studies. Epidemiol Infect 2020; 148:e10. [PMID: 31959273 PMCID: PMC7019487 DOI: 10.1017/s0950268819002255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Population network structures, graph theory, algorithms to match subgraphs may lead to better clustering of households and communities in epidemiological studies: a response. Epidemiol Infect 2020; 148:e3. [PMID: 31918778 PMCID: PMC7019080 DOI: 10.1017/s0950268819002243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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