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Alamneh TS, Walker JG, Lim AG, Alam E, Hamid S, Foster GR, Choudhry N, Ansari MA, Qureshi H, Vickerman P. Changes in the prevalence of hepatitis B and C viral infections in Sindh province, Pakistan: Findings from two sero-surveys in 2007 and 2019. J Viral Hepat 2024. [PMID: 39056891 DOI: 10.1111/jvh.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/06/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Pakistan harbours a large burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. We utilised repeat sero-surveys to assess progress achieved towards hepatitis elimination in Pakistan. Multilevel logistic regression evaluated the change in HBV infection (HBV surface antigen (HBsAg)-positive) prevalence and HCV exposure (HCV antibody (HCV-Ab)-positive) prevalence between two sero-surveys from 2007 and 2019 for Sindh province and associated risk factors. Adjusted odds ratios (aORs) were estimated and population-attributable fractions (PAF) for modifiable risk factors for HCV exposure. The 2007 and 2019 surveys included 8855 and 6672 individuals. HBsAg prevalence decreased from 2.6% (95% confidence intervals (95% CI): 2.2-2.9) in 2007 to 1.1% (95% CI: 0.8-1.3) in 2019, while HCV-Ab prevalence increased from 5.1% (95% CI: 4.6%-5.5%) to 6.2% (95% CI: 5.6%-6.8%). The age and gender-adjusted HBsAg prevalence decreased by 80% (aOR = 0.2, 95% CI: 0.1-0.4) among children and 60% (aOR = 0.4, 95% CI: 0.3-0.6) among adults over 2007-2019, while HCV-Ab prevalence decreased by 60% (aOR = 0.4, 95%CI:0.2-0.7) in children and increased by 40% (aOR = 1.4, 95% CI: 1.2-1.7) in adults. HCV-Ab prevalence was lower in adults with secondary (aOR = 0.6, 95% CI: 0.5-0.8) and higher (aOR = 0.5, 95%CI:0.3-0.8) education compared to illiterates and higher among adults reporting blood transfusion (aOR = 1.7, 95% CI: 1.2-2.4), family history of hepatitis (aOR = 2.5, 95% CI: 1.9-3.3), past year medical injection (aOR = 2.1, 95% CI: 1.6-2.7), being tattooed (aOR = 1.4, 95% CI: 1.0-1.9) and shaved by traditional barber (aOR = 1.2, 95% CI: 1.0-1.5). Modifiable risk factors accounted for 45% of HCV exposure, with medical injection(s) accounting for 38% (95%CI,25.7-48.4%). Overall HCV has increased over 2007-2019 in Sindh province, while HBV prevalence has decreased. Medical injections should be an important focus of prevention activities.
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Affiliation(s)
- Tesfa Sewunet Alamneh
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ejaz Alam
- Pakistan Health Research Council Research Centre, Karachi, Pakistan
| | | | | | | | - M Azim Ansari
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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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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Baliashvili D, Averhoff F, Kasradze A, Salyer SJ, Kuchukhidze G, Gamkrelidze A, Imnadze P, Alkhazashvili M, Chanturia G, Chitadze N, Sukhiashvili R, Blanton C, Drobeniuc J, Morgan J, Hagan LM. Risk factors and genotype distribution of hepatitis C virus in Georgia: A nationwide population-based survey. PLoS One 2022; 17:e0262935. [PMID: 35061841 PMCID: PMC8782338 DOI: 10.1371/journal.pone.0262935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/08/2022] [Indexed: 12/02/2022] Open
Abstract
In preparation for the National Hepatitis C Elimination Program in the country of Georgia, a nationwide household-based hepatitis C virus (HCV) seroprevalence survey was conducted in 2015. Data were used to estimate HCV genotype distribution and better understand potential sex-specific risk factors that contribute to HCV transmission. HCV genotype distribution by sex and reported risk factors were calculated. We used explanatory logistic regression models stratified by sex to identify behavioral and healthcare-related risk factors for HCV seropositivity, and predictive logistic regression models to identify additional variables that could help predict the presence of infection. Factors associated with HCV seropositivity in explanatory models included, among males, history of injection drug use (IDU) (aOR = 22.4, 95% CI = 12.7, 39.8) and receiving a blood transfusion (aOR = 3.6, 95% CI = 1.4, 8.8), and among females, history of receiving a blood transfusion (aOR = 4.0, 95% CI 2.1, 7.7), kidney dialysis (aOR = 7.3 95% CI 1.5, 35.3) and surgery (aOR = 1.9, 95% CI 1.1, 3.2). The male-specific predictive model additionally identified age, urban residence, and history of incarceration as factors predictive of seropositivity and were used to create a male-specific exposure index (Area under the curve [AUC] = 0.84). The female-specific predictive model had insufficient discriminatory performance to support creating an exposure index (AUC = 0.61). The most prevalent HCV genotype (GT) nationally was GT1b (40.5%), followed by GT3 (34.7%) and GT2 (23.6%). Risk factors for HCV seropositivity and distribution of HCV genotypes in Georgia vary substantially by sex. The HCV exposure index developed for males could be used to inform targeted testing programs.
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Affiliation(s)
- Davit Baliashvili
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- * E-mail: ,
| | - Francisco Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ana Kasradze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Stephanie J. Salyer
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Paata Imnadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Gvantsa Chanturia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | - Curtis Blanton
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Juliette Morgan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Global Disease Detection – South Caucasus Regional Center, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | - Liesl M. Hagan
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Saleem U, Aslam N, Siddique R, Iqbal S, Manan M. Hepatitis C virus: Its prevalence, risk factors and genotype distribution in Pakistan. EUR J INFLAMM 2022. [DOI: 10.1177/1721727x221144391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatitis C is a dangerous liver disease transmitted by Hepatitis C virus (HCV). HCV constitutes an important health issue in Pakistan. In Pakistani setting HCV is found frequently and is recognized as an alarming health problem. In this cross sectional study we reviewed published data regarding the seroprevalence of hepatitis C in general community, blood donors and pregnant females and risk factors linked with its occurrence in Pakistan. Data retrieved from163 studies published from 2001 to 2022 was utilized and weighted mean was calculated. Data of 1,875,232 individuals was collected and arranged into three groups, depending upon the population type such as (1) general population, (2) pregnant women, (3) blood donors. General population (765,426) and blood donors (973,260) formed the most of population. Mean Hepatitis C virus prevalence in general public and blood donors was 16.47% and 8.2% respectively. In pregnant females (136,546) the mean frequency was 9.3%. This study exhibits that the frequency of Hepatitis C in general population, pregnant females and blood donors groups was 11.32%. The data suggested that risks factors for transmitting HCV infection in Pakistan include unsterilized needle use, blood transfusions, shaving by barbers, lack of trained staff, needle stick injuries, injection drug users, household contacts/spousal transmission, unsterilized dental and surgical Instruments, improper disposal of hospital waste, poor infra-structure and others. The frequency of HCV infection is distressing in Pakistan. Health education and awareness programs are needed for decreasing Hepatitis C infection in Pakistan. The data necessitate the implementation of preventive and remedial approaches to decrease the disease load and mortality in Pakistan.
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Affiliation(s)
- Uzma Saleem
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Nosheen Aslam
- Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan
| | - Rida Siddique
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Shabnoor Iqbal
- Department of Zoology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Maria Manan
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
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Abid A, Uddin M, Muhammad T, Awan S, Applegate T, Dore GJ, Cloherty G, Hamid S. Evaluation of Hepatitis C Virus Core Antigen Assay in a Resource-Limited Setting in Pakistan. Diagnostics (Basel) 2021; 11:diagnostics11081354. [PMID: 34441289 PMCID: PMC8394911 DOI: 10.3390/diagnostics11081354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 01/20/2023] Open
Abstract
The diagnosis of Hepatitis C virus (HCV) infection can be challenging due to its cost and a lack of access to centralized testing. There is an urgent need to develop simplified HCV testing algorithms. The aim of this study was to evaluate the performance characteristics of a Hepatitis C core antigen (HCVcAg) assay in a decentralized, resource-limited setting. This is a descriptive cross-sectional study from a highly endemic area of Karachi, Pakistan. Between October 2019 and July 2020, subjects aged 12 years and above who screened positive for HCV antibodies were simultaneously tested for HCV RNA (Xpert HCV Viral Load, GeneXpert® IV, Cepheid, France) and HCVcAg (ARCHITECT HCV Ag assay, Abbott® Diagnostics) to confirm active HCV infection. An Abbott ARCHITECT® i1000SR Immunoassay Analyser was installed at a local district hospital as a point-of-care (POC) facility for HCVcAg testing, while samples for HCV RNA were tested in a central lab. Two hundred individuals (mean age 46.4 ± 14.5 years, 71.5% females), who screened positive for HCV antibody, were included in the study. HCV RNA was detected in 128 (64.0%) while HCVcAg was reactive in 119 (59.5%) cases. Performance of the Immunoassay Analyser was excellent with a higher throughput and quicker readout value compared to the GeneXpert System. The sensitivity and specificity of HCVcAg (≥10 fmol/L) at HCV RNA thresholds of ≥12 was 99.1% (95% CI: 95–100%) and 87.6% (95%CI: 78.4–94%). A strong agreement was observed between the HCVcAg assay and HCV RNA. The ARCHITECT HCV Ag assay showed high sensitivity and specificity compared to HCV RNA in a decentralized, resource-limited setting. It can therefore be used as a confirmatory test in HCV elimination programs, particularly for low-income countries such as Pakistan.
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Affiliation(s)
- Adeel Abid
- Department of Medicine, Aga Khan University, Stadium Road, Karachi 74800, Pakistan; (A.A.); (M.U.); (T.M.); (S.A.)
| | - Murad Uddin
- Department of Medicine, Aga Khan University, Stadium Road, Karachi 74800, Pakistan; (A.A.); (M.U.); (T.M.); (S.A.)
| | - Taj Muhammad
- Department of Medicine, Aga Khan University, Stadium Road, Karachi 74800, Pakistan; (A.A.); (M.U.); (T.M.); (S.A.)
| | - Safia Awan
- Department of Medicine, Aga Khan University, Stadium Road, Karachi 74800, Pakistan; (A.A.); (M.U.); (T.M.); (S.A.)
| | - Tanya Applegate
- Kirby Institute, Viral Hepatitis Clinical Research Program, UNSW Sydney, Sydney, NSW 2052, Australia; (T.A.); (G.J.D.)
| | - Gregory J. Dore
- Kirby Institute, Viral Hepatitis Clinical Research Program, UNSW Sydney, Sydney, NSW 2052, Australia; (T.A.); (G.J.D.)
| | | | - Saeed Hamid
- Department of Medicine, Aga Khan University, Stadium Road, Karachi 74800, Pakistan; (A.A.); (M.U.); (T.M.); (S.A.)
- Correspondence:
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Cailhol J, Khan N. Chronic hepatitis and HIV risks amongst Pakistani migrant men in a French suburb and insights into health promotion interventions: the ANRS Musafir qualitative study. BMC Public Health 2020; 20:1393. [PMID: 32919467 PMCID: PMC7488669 DOI: 10.1186/s12889-020-09459-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 08/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Seine-Saint-Denis is a deprived departement (French administrative unit) in the North-East of Paris, France, hosting the majority of South Asian migrants in France. In recent years, the number of migrants from Pakistan, which has a high prevalence of hepatitis C globally, increased. As a corollary, this study addressed the high proportion of Pakistani patients in the infectious diseases clinic of a local hospital, diagnosed with hepatitis C, but also hepatitis B and Human Immunodeficiency Virus (HIV). It explored genealogies and beliefs about hepatitis and HIV transmission, including community, sexual and blood risk behaviours. The aim was to understand the ways these risk factors reduce or intensify both en route and once in France, in order to devise specific forms of community health intervention. METHODS The study took place at Avicenne University-Hospital in Seine-Saint-Denis, and its environs, between July and September 2018. The design of the study was qualitative, combining semi-structured interviews, a focus group discussion, and ethnographic observations. The sample of Pakistani participants was selected from those followed-up for chronic hepatitis C, B, and/or HIV at Avicenne, and who had arrived after 2010 in Seine-Saint-Denis. RESULTS Thirteen semi-structured interviews were conducted, until saturation was reached. All participants were men from rural Punjab province. Most took the Eastern Mediterranean human smuggling route. Findings suggest that vulnerabilities to hepatitis and HIV transmission, originating in Pakistan, are intensified along the migration route and perpetuated in France. Taboo towards sexuality, promiscuity in cohabitation conditions, lack of knowledge about transmission were amongst the factors increasing vulnerabilities. Participants suggested a number of culturally-acceptable health promotion interventions in the community, such as outreach awareness and testing campaigns in workplaces, health promotion and education in mosques, as well as web-based sexual health promotion tools to preserve anonymity. CONCLUSIONS Our findings highlight the need to look at specific groups at risk, related to their countries of origin. In-depth understandings of such groups, using interdisciplinary approaches such as were employed here, can allow for culturally adapted, tailored interventions. However, French colour-blind policies do not easily permit such kinds of targeted approach and this limitation requires further debate.
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Affiliation(s)
- Johann Cailhol
- Infectious diseases department, Avicenne University Hospital, 125, route de Stalingrad, 93007 Bobigny, France
- Laboratoire d’Educations et des Pratiques de Santé, Université Paris 13, Bobigny, France
| | - Nichola Khan
- Centre for Research in Spatial, Environmental, and Cultural Politics, School of Applied Social Science, University of Brighton, Brighton, UK
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Clementi E, Bartlett S, Otterstatter M, Buxton JA, Wong S, Yu A, Butt ZA, Wilton J, Pearce M, Jeong D, Binka M, Adu P, Alvarez M, Samji H, Abdia Y, Wong J, Krajden M, Janjua NZ. Syndemic profiles of people living with hepatitis C virus using population-level latent class analysis to optimize health services. Int J Infect Dis 2020; 100:27-33. [PMID: 32810594 DOI: 10.1016/j.ijid.2020.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hepatitis C (HCV) affects diverse populations such as people who inject drugs (PWID), 'baby boomers,' gay/bisexual men who have sex with men (gbMSM), and people from HCV endemic regions. Assessing HCV syndemics (i.e.relationships with mental health/chronic diseases) among subpopulations using Latent Class Analysis (LCA) may facilitate targeted program planning. METHODS The BC Hepatitis Testers Cohort(BC-HTC) includes all HCV cases identified in BC between 1990 and 2015, integrated with medical administrative data. LCA grouped all BC-HTC HCV diagnosed people(n = 73,665) by socio-demographic/clinical indicators previously determined to be relevant for HCV outcomes. The final model was chosen based on fit statistics, epidemiological meaningfulness, and posterior probability. Classes were named by most defining characteristics. RESULTS The six-class model was the best fit and had the following names and characteristics: 'Younger PWID'(n =11,563): recent IDU (67%), people born >1974 (48%), mental illness (62%), material deprivation (59%). 'Older PWID'(n =15,266): past IDU (78%), HIV (17%), HBV (17%) coinfections, alcohol misuse(68%). 'Other Middle-Aged People'(n = 9019): gbMSM (26%), material privilege (31%), people born between 1965-1974 (47%). 'People of Asian backgrounds' (n = 4718): East/South Asians (92%), no alcohol misuse (97%) or mental illness (93%), people born <1945 (26%), social privilege (66%). 'Rural baby boomers' (n = 20,401): rural dwellers (32%), baby boomers (79%), heterosexuals (99%), no HIV (100%). 'Urban socially deprived baby boomers' (n = 12,698): urban dwellers (99%), no IDU (100%), liver disease (22%), social deprivation (94%). CONCLUSIONS Differences between classes suggest variability in patients' service needs. Further analysis of health service utilization patterns may inform optimal service layout.
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Affiliation(s)
- Emilia Clementi
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Sofia Bartlett
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada; University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Otterstatter
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Stanley Wong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Amanda Yu
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Zahid A Butt
- BC Centre for Disease Control, Vancouver, BC, Canada; University of Waterloo Faculty of Applied Health Sciences, Waterloo, ON, Canada
| | - James Wilton
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Margo Pearce
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Dahn Jeong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mawuena Binka
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Hasina Samji
- BC Centre for Disease Control, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Younathan Abdia
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Jason Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mel Krajden
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.
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Makuza JD, Nisingizwe MP, Rwema JOT, Dushimiyimana D, Habimana DS, Umuraza S, Serumondo J, Ngwije A, Semakula M, Gupta N, Nsanzimana S, Janjua NZ. Role of unsafe medical practices and sexual behaviours in the hepatitis B and C syndemic and HIV co-infection in Rwanda: a cross-sectional study. BMJ Open 2020; 10:e036711. [PMID: 32660951 PMCID: PMC7359181 DOI: 10.1136/bmjopen-2019-036711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study describes the burden of the hepatitis B, C and HIV co-infections and assesses associated risk factors. SETTING This analysis used data from a viral hepatitis screening campaign conducted in six districts in Rwanda from April to May 2019. Ten health centres per district were selected according to population size and distance. PARTICIPANTS The campaign collected information from 156 499 participants (51 496 males and 104 953 females) on sociodemographic, clinical and behavioural characteristics. People who were not Rwandan by nationality or under 15 years old were excluded. PRIMARY AND SECONDARY OUTCOMES The outcomes of interest included chronic hepatitis C virus (HCV) infection, chronic hepatitis B virus (HBV) infection, HIV infection, co-infection HIV/HBV, co-infection HIV/HCV, co-infection HBV/HCV and co-infection HCV/HBV/HIV. Multivariable logistic regressions were used to assess factors associated with HBV, HCV and HIV, mono and co-infections. RESULTS Of 156 499 individuals screened, 3465 (2.2%) were hepatitis B surface antigen positive and 83% (2872/3465) of them had detectable HBV desoxy-nucleic acid (HBV DNA). A total of 4382 (2.8%) individuals were positive for antibody-HCV (anti-HCV) and 3163 (72.2%) had detectable HCV ribo-nucleic acid (RNA). Overall, 36 (0.02%) had HBV/HCV co-infection, 153 (0.1%) HBV/HIV co-infection, 238 (0.15%) HCV/HIV co-infection and 3 (0.002%) had triple infection. Scarification or receiving an operation from traditional healer was associated with all infections. Healthcare risk factors-history of surgery or transfusion-were associated with higher likelihood of HIV infection with OR 1.42 (95% CI 1.21 to 1.66) and OR 1.48 (1.29 to 1.70), respectively, while history of physical traumatic assault was associated with a higher likelihood of HIV and HBV/HIV co-infections with OR 1.69 (95% CI 1.51 to 1.88) and OR 1.82 (1.08 to 3.05), respectively. CONCLUSIONS Overall, mono-infections were common and there were differences in significant risk factors associated with various infections. These findings highlight the magnitude of co-infections and differences in underlying risk factors that are important for designing prevention and care programmes.
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Affiliation(s)
| | - Marie Paul Nisingizwe
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Center for Teaching and Learning, Baltimore, Maryland, USA
| | | | | | - Sabine Umuraza
- Health Department, Clinton Health Access Initiative, Kigali, Rwanda
| | | | - Alida Ngwije
- Health Department, Clinton Health Access Initiative, Kigali, Rwanda
| | - Muhamed Semakula
- IHDPC, Rwanda Biomedical Center, Kigali, Kigali City, Rwanda
- I-Biostat Department of Sciences, Hasselt University, Hasselt, Limburg, Belgium
| | - Neil Gupta
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Naveed Zafar Janjua
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Center for Diseases Control, Vancouver, British Columbia, Canada
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Averbukh LD, Wu GY. Highlights for Dental Care as a Hepatitis C Risk Factor: A Review of Literature. J Clin Transl Hepatol 2019; 7:346-351. [PMID: 31915604 PMCID: PMC6943210 DOI: 10.14218/jcth.2019.00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/22/2019] [Accepted: 10/08/2019] [Indexed: 12/31/2022] Open
Abstract
Hepatitis C (HCV) is a viral infection that affects an estimated 71 million people worldwide, with over 1 million new infections yearly. While medical treatments exist, HCV continues to be a significant public health concern. Primary prevention and transmission risk factor identification remain key in helping decrease disease prevalence. While intravenous drug use, healthcare exposure (i.e. blood transfusions and surgical care), and body modification (i.e. tattooing and piercings) are well accepted risk factors for HCV transmission, others remain controversial. Because dental practice is often associated with procedures and bleeding, the possibility of HCV transmission seemed reasonable to investigate. Here, we review the evidence for dental care as a potential risk factor for HCV transmission. We identified a total of 1,180 manuscripts related to HCV and dental care, of which 26 manuscripts were included in the study after exclusionary criteria were applied. As per our review of the available literature, in the developing world, the improper use of sterile technique and lack of provider education likely increases the risk of HCV transmission during dental care. In developed nations, on the other hand, general dental care does not appear to be a significant risk factor for HCV transmission in non-intravenous drug user patients; although, the improper use and reuse of anesthetics during procedures poses a rare potential risk for viral transmission.
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Affiliation(s)
- Leon D. Averbukh
- Correspondence to: Leon D. Averbukh, Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, 236 Farmington Ave., Farmington, CT 06030, USA. Tel: +1-347-306-4752, Fax: +1-860-679-1025, E-mail:
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10
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Hayashi T, Hutin YJF, Bulterys M, Altaf A, Allegranzi B. Injection practices in 2011-2015: a review using data from the demographic and health surveys (DHS). BMC Health Serv Res 2019; 19:600. [PMID: 31455315 PMCID: PMC6712605 DOI: 10.1186/s12913-019-4366-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022] Open
Abstract
Background Reuse of injection devices to give healthcare injections decreased from 39.8 to 5.5% between 2000 and 2010, but trends since 2011 have not been described. We reviewed results of Demographic and Health Surveys (DHS) to describe injection practices worldwide from 2011 to 2015. Methods We searched the DHS Internet site for data published on injection practices conducted in countries from 2011 to 2015, extracted information on frequency (number of healthcare injections per person in the last 12 months) and safety (proportion of syringes and needles taken from a new, unopened package). We compared gender groups and WHO regions in terms of frequency and safety. For countries with data available, we compared injection practices 2004–2010 and 2011–2015. Results Since 2011, 40 of 92 countries (43%) that conducted DHS surveys reported on injection practices. On average, the frequency of injection was 1.64 per person per year (from 3.84 in WHO Eastern Mediterranean region to 1.18 in WHO African region). Among those, 96.1% of injections reportedly used new injection devices (from 90.2% in the WHO Eastern Mediterranean region to 98.8% in the WHO Western Pacific region). On average, women received more injections per year (1.85) than men (1.41). Among 16 (40%) countries with data in 2004–2010 and 2011–2015, 69% improved in terms of safety. The annual number of unsafe injections reduced in 81% of countries. In Pakistan, the number of unsafe injections was the highest and did not decrease between 2006 and 2012. Conclusions Injection practices have continued to improve in most countries worldwide, although the Eastern Mediterranean region in particular still faces unsafe practices that are not improving. Further efforts are needed to eliminate unsafe injection practices in health care settings, including through the use of reuse-prevention devices. Despite some limitations, DHS is an easily available method to measure progress over time.
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Affiliation(s)
- Tomoyuki Hayashi
- Global Hepatitis Programme, World Health Organization, Geneva, Switzerland. .,Department of Gastroenterology, Kanazawa University and WHO Collaborating Center for Chronic Hepatitis and Liver Cancer, Kanazawa, Ishikawa, Japan.
| | - Yvan J-F Hutin
- Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Marc Bulterys
- Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Arshad Altaf
- Integrated Service Delivery, World Health Organization, Western Pacific Region, Manila, Philippines
| | - Benedetta Allegranzi
- Infection Prevention and Control, World Health Organization, Geneva, Switzerland
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Lim AG, Qureshi H, Mahmood H, Hamid S, Davies CF, Trickey A, Glass N, Saeed Q, Fraser H, Walker JG, Mukandavire C, Hickman M, Martin NK, May MT, Averhoff F, Vickerman P. Curbing the hepatitis C virus epidemic in Pakistan: the impact of scaling up treatment and prevention for achieving elimination. Int J Epidemiol 2019; 47:550-560. [PMID: 29309592 PMCID: PMC5913612 DOI: 10.1093/ije/dyx270] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 02/07/2023] Open
Abstract
Background The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve the WHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide. Methods We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets. Results With no further treatment (currently ∼150 000 treated annually) during 2016–30, chronic HCV prevalence will increase from 3.9% to 5.1%, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80% treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually. Conclusions Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan’s HCV burden will increase markedly.
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Affiliation(s)
- Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Huma Qureshi
- Pakistan Health Research Council, Islamabad, Pakistan
| | - Hassan Mahmood
- Pakistan Health Research Council, Islamabad, Pakistan.,TEPHINET, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Charlotte F Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nancy Glass
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quaid Saeed
- National AIDS Control Programme, Islamabad, Pakistan
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Division of Global Public Health, Department of Medicine, University of California San Diego, CA, USA
| | - Margaret T May
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Francisco Averhoff
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Krajden M, Cook D, Janjua NZ. Contextualizing Canada's hepatitis C virus epidemic. CANADIAN LIVER JOURNAL 2018; 1:218-230. [PMID: 35992621 PMCID: PMC9202764 DOI: 10.3138/canlivj.2018-0011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 07/29/2023]
Abstract
In 2016, Canada signed on to the World Health Organization (WHO) 2030 hepatitis C virus (HCV) disease elimination targets. Most of Canada's HCV disease burden is among five disproportionately affected population groups: 1) Baby boomers, who are at increased risk of dying from decompensated cirrhosis and hepatocellular carcinoma and for whom one-time screening should be recommended to identify those undiagnosed; 2) People who inject drugs (PWID), whose mortality risks include HCV infection, HCV acquisition risks and co-morbid conditions. While HCV infection in PWID can be effectively cured with direct-acting antivirals, premature deaths from acquisition risks, now exacerbated by Canada's opioid crisis, will need to be addressed to achieve the full benefits of curative treatment. PWID require syndemic-based solutions (harm reduction, addictions and mental health support, and management of co-infections, including HIV); 3) Indigenous populations who will require wellness-based health promotion, prevention, care and treatment designed by Indigenous people to address their underlying health disparities; 4) Immigrants who will require culturally designed and linguistically appropriate services to enhance screening and engagement into care; and (5) For those incarcerated because of drug-related crimes, decriminalization and better access to harm reduction could help reduce the impact of HCV infections and premature mortality. A comprehensive prevention, care and treatment framework is needed for Canada's vulnerable populations, including those co-infected with HIV, if we are to achieve the WHO HCV elimination targets by 2030. The aim of this review is to describe the HCV epidemic in the Canadian context.
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Affiliation(s)
- Mel Krajden
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
- Dept. of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia
| | - Darrel Cook
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
| | - Naveed Z Janjua
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
- School of Population and Public Health, University of British Columbia, Vancouver British Columbia
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Flanagan S, Kunkel J, Appleby V, Eldridge SE, Ismail S, Moreea S, Griffiths C, Walton R, Pitt M, Salmon A, Madurasinghe V, Barnes E, Simms E, Agarwal K, Foster GR. Case finding and therapy for chronic viral hepatitis in primary care (HepFREE): a cluster-randomised controlled trial. Lancet Gastroenterol Hepatol 2018; 4:32-44. [PMID: 30477810 DOI: 10.1016/s2468-1253(18)30318-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The prevalence of viral hepatitis (hepatitis B virus and hepatitis C virus) in migrants is higher than among the general population in many high-income countries. We aimed to determine whether incentivising and supporting primary-care physicians in areas with a high density of migrants increases the numbers of adult migrants screened for viral hepatitis. METHODS HepFREE was a multicentre, open, cluster-randomised controlled trial in general practices in areas of the UK with a high density of migrants (Bradford, Yorkshire, and northeast and southeast London). Participants were adult patients (aged 18 years or older) in primary care, who had been identified as a first or second generation migrant from a high-risk country. General practices were randomly assigned (1:2:2:2:2) to an opportunistic screening (control) group or to one of four targeted screening (interventional) groups: standard (ie, hospital-based) care and a standard invitation letter; standard care and an enhanced invitation letter; community care and a standard invitation letter; or community care and an enhanced invitation letter. In control screening, general practitioners (GPs) were given a teaching session on viral hepatitis and were asked to test all registered migrants. In the intervention, GPs were paid a nominal sum for setting up searches of records, reimbursed for signed consent forms, and supported by a dedicated clinician. Patients who were eligible for testing and tested positive for viral hepatitis in the intervention groups were eligible to enrol in a second embedded trial of community versus hospital based care. The primary outcomes were the proportion of patients eligible for screening, the proportion of those eligible who were sent an invitation letter in the intervention groups, the uptake of viral hepatitis screening (in the intention-to-treat population), the proportion of patients who tested positive for viral hepatitis, the proportion who complied with treatment, and the cost-effectiveness of the intervention. This trial is registered with ISRCTN, number ISRCTN54828633. FINDINGS Recruitment and testing ran from Oct 31, 2013, to Feb 4, 2017, and each practice recruited for 18 consecutive calendar months. We approached 70 general practices in three areas with a high density of migrants, of which 63 general practices agreed to participate. Five practices withdrew and 58 practices were randomly assigned: eight to control and 50 to an intervention. In control practices, 26 046 (38·4%) of 67 820 patients who were initially registered were eligible for testing, as were 152 321 (43·3%) of 351 710 patients in the interventional groups in London and Bradford. Of 51 773 randomly selected eligible patients in the intervention groups in London and Bradford, letters were sent to 43 585 (84·2%) patients. In the eight control general practices, screening was taken up by 543 (1·7%) of 31 738 eligible participants, which included 5692 newly registered patients. However, in the 50 general practices that used the intervention, screening was taken up by 11 386 (19·5%) of 58 512 eligible participants (including 6739 newly registered patients; incidence rate ratio 3·70, 95% CI 1·30-10·51; p=0·014) and this intervention was cost-effective. 720 (4·5%) of 15 844 patients who received a standard letter versus 1032 (3·7%) of 28 095 patients who received the enhanced letter were tested (0·70, 0·38-1·31; p=0·26). In the control group, 17 patients tested positive for viral hepatitis, as did 220 patients (one with a co-infection) in the intervention groups. In the embedded study, 220 patients were randomly assigned to either hospital-based care or community care; 80 (87·9%) of 91 patients in the hospital setting complied with treatment versus 105 (81·4%) of 129 patients in the community setting. The intervention was cost-effective at willingness to pay thresholds in excess of £8540. One serious adverse event (thyroiditis) was noted. INTERPRETATION Screening migrants for viral hepatitis in primary care is effective if doctors are incentivised and supported. Community care is expensive and there is no evidence that this offers benefits in this setting or that bespoke invitation letters add value. We suggest that bespoke invitation letters should not be used, and we suggest that outreach, community-based services for migrants should not be developed. FUNDING National Institute for Health Research.
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Affiliation(s)
- Stuart Flanagan
- Barts Liver Centre, Queen Mary University of London, London, UK
| | - Jan Kunkel
- Barts Liver Centre, Queen Mary University of London, London, UK
| | - Victoria Appleby
- Department of Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Sharif Ismail
- Barts Liver Centre, Queen Mary University of London, London, UK
| | - Sulleman Moreea
- Department of Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Robert Walton
- Blizard Institute, Queen Mary University of London, London, UK
| | - Martin Pitt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Andrew Salmon
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Eleanor Barnes
- Nuffield Department of Medicine and Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Elizabeth Simms
- Nuffield Department of Medicine and Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | | | - Graham R Foster
- Barts Liver Centre, Queen Mary University of London, London, UK.
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Patoli BB, Patoli AA, Balani NK, Korejo AA. Molecular surveillance of HCV mono-infection and HCV-HBV co-infection in symptomatic population at Hyderabad, Pakistan. Afr Health Sci 2018; 18:531-538. [PMID: 30602984 PMCID: PMC6307001 DOI: 10.4314/ahs.v18i3.9] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pakistan is endemic to hepatitis B and C infections. Alarming rise in hepatitis C virus (HCV) infection has been noticed in some areas of Sindh with an increasing risk for co-infection frequency in this region. OBJECTIVE To estimate the burden of HBV/HCV infection in Hyderabad Pakistan. METHODS ELISA and Nucleic acid Amplification test were performed to detect viruses. SPSS and online calculator were used for statistical analysis. RESULTS From a total of 108 seropositive hepatitis patients, 36.1% (n=39) were found HCV RNA-positive. Non-significant differences were observed in the frequencies of HCV infection for both genders [OR=0.735, CI (95%) 0.307-1.761, p<0.05]. The percentage of HBV DNA detection among 108 HCV-seropositive cases was 17.9% (n=19). However, HCV-HBV co-infection in HCV-RNA positive cases was determined in 48.7% (n=19) cases with non-significant difference in both genders [OR=1.51, CI (95%) = 0.38 - 5.96, p< 0.05]. Analysis suggested weakly positive correlation between HCV mono-infection and HCV-HBV co-infection and age (r =0.184, and r =0.1231), respectively. CONCLUSION The study demonstrates a high prevalence of HBV co-infection among active hepatitis C patients of Hyderabad.
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Al Kanaani Z, Mahmud S, Kouyoumjian SP, Abu-Raddad LJ. The epidemiology of hepatitis C virus in Pakistan: systematic review and meta-analyses. ROYAL SOCIETY OPEN SCIENCE 2018; 5:180257. [PMID: 29765698 PMCID: PMC5936963 DOI: 10.1098/rsos.180257] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/13/2018] [Indexed: 05/06/2023]
Abstract
To characterize hepatitis C virus (HCV) epidemiology in Pakistan and estimate the pooled mean HCV antibody prevalence in different risk populations, we systematically reviewed all available records of HCV incidence and/or prevalence from 1989 to 2016, as informed by the Cochrane Collaboration Handbook. This systematic review was reported following the PRISMA guidelines. Populations were classified into six categories based on the risk of exposure to HCV infection. Meta-analyses were performed using DerSimonian and Laird random-effects models with inverse variance weighting. The search identified one HCV incidence study and 341 prevalence measures/strata. Meta-analyses estimated the pooled mean HCV prevalence at 6.2% among the general population, 34.5% among high-risk clinical populations, 12.8% among populations at intermediate risk, 16.9% among special clinical populations, 55.9% among populations with liver-related conditions and 53.6% among people who inject drugs. Most reported risk factors in analytical epidemiologic studies related to healthcare procedures. Pakistan is enduring an HCV epidemic of historical proportions-one in every 20 Pakistanis is infected. HCV plays a major role in liver disease burden in this country, and HCV prevalence is high in all-risk populations. Most transmission appears to be driven by healthcare procedures. HCV treatment and prevention must become a national priority.
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Affiliation(s)
- Zaina Al Kanaani
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, PO Box 24144, Doha, Qatar
| | - Sarwat Mahmud
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, PO Box 24144, Doha, Qatar
| | - Silva P. Kouyoumjian
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, PO Box 24144, Doha, Qatar
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, PO Box 24144, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY, USA
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Benova L, Awad SF, Abu-Raddad LJ. Estimate of vertical transmission of Hepatitis C virus in Pakistan in 2007 and 2012 birth cohorts. J Viral Hepat 2017; 24:1177-1183. [PMID: 28662284 DOI: 10.1111/jvh.12748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/06/2017] [Indexed: 12/12/2022]
Abstract
UNLABELLED Despite a combination of high Hepatitis C virus (HCV) prevalence, a large adult population and high fertility, no published estimates of the scale and contribution of vertical transmission to HCV incidence in Pakistan exist. The objective of this study was to estimate the number of new HCV infections occurring in Pakistan as a result of vertical transmission. We adapted a published mathematical model based on HCV antibody and viraemia prevalence, fertility rates, risk of HCV vertical transmission and children mortality rates to estimate the number of infections in the 2007 and 2012 birth cohorts nationally and in four subnational regions. We estimated that 19 708 (95% uncertainty interval [UI]: 15 941-23 819) children were vertically infected by HCV in 2007 and 21 676 (95% UI: 17 498-26 126) in 2012. The majority of these cases (72.9% and 72.5% in 2007 and 2012, respectively) occurred in Punjab. We estimated that vertical transmission as a mode of exposure accounted for a quarter of HCV infections among children under 5 years of age (25.2% in 2007 and 24.0% in 2012). CONCLUSION Our results showed that one in 260 children born in Pakistan in 2007 and 2012 acquired HCV vertically. While currently no interventions during pregnancy and childbirth are recommended to reduce this risk, prevention, testing and treatment strategies should be considered to reduce the burden of vertical HCV infections among young children. Other routes of transmission appear to contribute the majority of HCV infections among children and must also be clarified and urgently addressed.
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Affiliation(s)
- Lenka Benova
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Susanne Faissal Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Laith Jamal Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY, USA.,College of Public Health, Hamad bin Khalifa University, Doha, Qatar
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Trickey A, May MT, Davies C, Qureshi H, Hamid S, Mahmood H, Saeed Q, Hickman M, Glass N, Averhoff F, Vickerman P. Importance and Contribution of Community, Social, and Healthcare Risk Factors for Hepatitis C Infection in Pakistan. Am J Trop Med Hyg 2017; 97:1920-1928. [PMID: 29141707 DOI: 10.4269/ajtmh.17-0019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pakistan has a high prevalence of hepatitis C virus (HCV) infection, estimated at 4.9% (2,290/46,843) in the 2007 national HCV seroprevalence survey. We used data from this survey to assess the importance of risk factor associations with HCV prevalence in Pakistan. Exposures were grouped as community (going to the barbers, sharing smoking equipment, having an ear/nose piercing, tattoo, or acupuncture), healthcare (ever having hemodialysis, blood transfusion, or ≥ 5 injections in the last year), demographic (marital status and age), and socio-economic (illiterate or laborer). We used mutually adjusted multivariable regression analysis, stratified by sex, to determine associations with HCV infection, their population attributable fraction, and how risk of infection accumulates with multiple exposures. Strength of associations was assessed using adjusted odds ratios (aOR). Community [aOR females 1.5 (95% confidence interval [CI]: 1.2, 1.8); males 1.2 (1.1, 1.4)] and healthcare [females 1.4 (1.2, 1.6); males 1.2 (1.1, 1.4)] exposures, low socio-economic status [females 1.6 (1.3, 1.80); males 1.3 (1.2, 1.5)], and marriage [females 1.5 (1.2, 1.9); males 1.4 (1.1, 1.8)] were associated with increased HCV infection. Among married women, the number of children was associated with an increase in HCV infection; linear trend aOR per child 1.06 (1.01, 1.11). Fewer infections could be attributed to healthcare exposures (females 13%; males 6%) than to community exposures (females 25%; males 9%). Prevalence increased from 3% to 10% when cumulative exposures increased from 1 to ≥ 4 [aOR per additional exposure for females 1.5 (1.4, 1.6); males 1.2 (1.2, 1.3)]. A combination of community, healthcare, and other factors appear to drive the Pakistan HCV epidemic, highlighting the need for a comprehensive array of prevention strategies.
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Affiliation(s)
- Adam Trickey
- Bristol Medical School, University of Bristol, Bristol, United Kingdom.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom
| | - Margaret T May
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Charlotte Davies
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Huma Qureshi
- Pakistan Medical Research Council (PMRC), Islamabad, Pakistan
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Hassan Mahmood
- Pakistan Medical Research Council (PMRC), Islamabad, Pakistan
| | - Quaid Saeed
- National AIDS Control Programme, Islamabad, Pakistan
| | - Matthew Hickman
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Nancy Glass
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Peter Vickerman
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Risk for hepatitis B and C virus transmission in nail salons and barbershops and state regulatory requirements to prevent such transmission in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 20:E20-30. [PMID: 25250760 DOI: 10.1097/phh.0000000000000042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT The potential for hepatitis B and C virus (HBV/HCV) transmission in nail salons and barbershops has been reported, but a systematic review has not been conducted. These businesses are regulated by state cosmetology or barbering boards, but adequacy of sanitary requirements has not been evaluated. OBJECTIVES To conduct literature review to assess risk for HBV/HCV transmission in nail salons and barbershops and to evaluate sanitary requirements in HBV/HCV prevention in these businesses in 50 states and District of Columbia. DESIGN Several search engines were used for literature search. Studies that quantified risks associated with manicuring, pedicuring, or barbering were included. State requirements for disinfection and sterilization were reviewed and evaluated. MAIN OUTCOME MEASURE For literature review, odds ratios, 95% confidence intervals, and confounding adjustment were extracted and evaluated. For regulation review, requirements for disinfection or sterilization for multiuse items in nail salons and barbershops were assessed according to the US federal guidelines. RESULTS Forty-six studies were identified and 36 were included in this study. Overall, the results were not consistent on risk for HBV/HCV transmission in nail salons and barbershops. For sanitary requirements, disinfection with an Environmental Protection Agency-registered disinfectant is required in 39 states for nail salons and in 26 states for barbershops. Sterilization was described in 15 states for nail salons and in 11 states for barbershops, but the majority of these states listed it as an optional approach. Sanitary requirements are consistent in states where 1 board regulates both businesses but are substantially discrepant in states with separate boards. CONCLUSIONS Current literature cannot confirm or exclude the risk for HBV/HCV transmission in nail salons and barbershops. Existing sanitary requirements are adequate in the majority of states, but compliance is needed to prevent HBV/HCV transmission in these businesses.
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Omata M, Kanda T, Wei L, Yu ML, Chuang WL, Ibrahim A, Lesmana CRA, Sollano J, Kumar M, Jindal A, Sharma BC, Hamid SS, Dokmeci AK, Al-Mahtab M, McCaughan GW, Wasim J, Crawford DHG, Kao JH, Yokosuka O, Lau GKK, Sarin SK. APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing. Hepatol Int 2016; 10:681-701. [PMID: 27229718 PMCID: PMC5003900 DOI: 10.1007/s12072-016-9736-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023]
Abstract
The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on "APASL consensus statements and recommendations for management of hepatitis C" in March 2015 to revise the "APASL consensus statements and management algorithms for hepatitis C virus infection" (Hepatol Int 6:409-435, 2012). The working party consisted of expert hepatologists from the Asian-Pacific region gathered at the Istanbul Congress Center, Istanbul, Turkey on 13 March 2015. New data were presented, discussed, and debated during the course of drafting a revision. Participants of the consensus meeting assessed the quality of the cited studies. The finalized recommendations for hepatitis C prevention, epidemiology, and laboratory testing are presented in this review.
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Affiliation(s)
- Masao Omata
- Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu-shi, Yamanashi, 400-8506, Japan.
- The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tatsuo Kanda
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China
| | - Ming-Lung Yu
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wang-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Alaaeldin Ibrahim
- GI/Liver Division, Department of Internal Medicine, University of Benha, Banha, Egypt
| | | | - Jose Sollano
- University Santo Tomas Hospital, Manila, Philippines
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Saeed S Hamid
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh
| | - Geofferey W McCaughan
- Royal Prince Alfred Hospital, Centenary Institute, University of Sydney, Sydney, Australia
| | - Jafri Wasim
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Darrell H G Crawford
- University of Queensland, School of Medicine, Woolloongabba, QLD, 4102, Australia
| | - Jia-Horng Kao
- National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Osamu Yokosuka
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - George K K Lau
- The Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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20
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Omata M, Kanda T, Wei L, Yu ML, Chuang WL, Ibrahim A, Lesmana CRA, Sollano J, Kumar M, Jindal A, Sharma BC, Hamid SS, Dokmeci AK, Mamun-Al-Mahtab, McCaughan GW, Wasim J, Crawford DHG, Kao JH, Yokosuka O, Lau GKK, Sarin SK. APASL consensus statements and recommendation on treatment of hepatitis C. Hepatol Int 2016; 10:702-26. [PMID: 27130427 PMCID: PMC5003907 DOI: 10.1007/s12072-016-9717-6] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/18/2016] [Indexed: 12/18/2022]
Abstract
The Asian-Pacific Association for the Study of the Liver (APASL) convened an international working party on the "APASL consensus statements and recommendation on management of hepatitis C" in March, 2015, in order to revise "APASL consensus statements and management algorithms for hepatitis C virus infection (Hepatol Int 6:409-435, 2012)". The working party consisted of expert hepatologists from the Asian-Pacific region gathered at Istanbul Congress Center, Istanbul, Turkey on 13 March 2015. New data were presented, discussed and debated to draft a revision. Participants of the consensus meeting assessed the quality of cited studies. Finalized recommendations on treatment of hepatitis C are presented in this review.
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Affiliation(s)
- Masao Omata
- Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu-Shi, Yamanashi, 400-8506, Japan.
- The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tatsuo Kanda
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Lai Wei
- Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Ming-Lung Yu
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wang-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Alaaeldin Ibrahim
- GI/Liver Division, Department of Internal Medicine, University of Benha, Benha, Egypt
| | | | - Jose Sollano
- University Santo Tomas Hospital, Manila, Philippines
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Saeed S Hamid
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mamun-Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh
| | - Geofferey W McCaughan
- Centenary Institute, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Jafri Wasim
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Darrell H G Crawford
- School of Medicine, University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Jia-Horng Kao
- National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Osamu Yokosuka
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - George K K Lau
- The Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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21
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Butt AS, Sharif F. Viral Hepatitis in Pakistan: Past, Present, and Future. Euroasian J Hepatogastroenterol 2016; 6:70-81. [PMID: 29201731 PMCID: PMC5578565 DOI: 10.5005/jp-journals-10018-1172] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 11/29/2015] [Indexed: 12/17/2022] Open
Abstract
Viral hepatitis is a major cause of morbidity and mortality worldwide and a rising cause for concern in Asian countries. Weather it is blood borne or water/food borne hepatotropic virus, increasing burden is alarming for Asian countries. In this review we have evaluated the existing data to estimate the burden of viral hepatitis in populations of all age groups nationwide, along with an assessment of the risk factors and preventive and management strategies currently employed in Pakistan. The aim of our work is to consolidate and supplement the present knowledge regarding viral hepatitis in light of past and present trends and to provide future direction to the existing health policies. How to cite this article Butt AS, Sharif F. Viral Hepatitis in Pakistan: Past, Present, and Future. Euroasian J Hepato-Gastroenterol 2016;6(1):70-81.
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Affiliation(s)
- Amna Subhan Butt
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Fatima Sharif
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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22
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Afzal MS. Are efforts up to the mark? A cirrhotic state and knowledge about HCV prevalence in general population of Pakistan. ASIAN PAC J TROP MED 2016; 9:616-8. [PMID: 27262079 DOI: 10.1016/j.apjtm.2016.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/16/2016] [Accepted: 04/08/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- Muhammad Sohail Afzal
- Department of Chemistry, School of Science, University of Management and Technology (UMT), Lahore, Pakistan.
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23
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Umer M, Iqbal M. Hepatitis C virus prevalence and genotype distribution in Pakistan: Comprehensive review of recent data. World J Gastroenterol 2016; 22:1684-1700. [PMID: 26819533 PMCID: PMC4721999 DOI: 10.3748/wjg.v22.i4.1684] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/11/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) is endemic in Pakistan and its burden is expected to increase in coming decades owing mainly to widespread use of unsafe medical procedures. The prevalence of HCV in Pakistan has previously been reviewed. However, the literature search conducted here revealed that at least 86 relevant studies have been produced since the publication of these systematic reviews. A revised updated analysis was therefore needed in order to integrate the fresh data. A systematic review of data published between 2010 and 2015 showed that HCV seroprevalence among the general adult Pakistani population is 6.8%, while active HCV infection was found in approximately 6% of the population. Studies included in this review have also shown extremely high HCV prevalence in rural and underdeveloped peri-urban areas (up to 25%), highlighting the need for an increased focus on this previously neglected socioeconomic stratum of the population. While a 2.45% seroprevalence among blood donors demands immediate measures to curtail the risk of transfusion transmitted HCV, a very high prevalence in patients attending hospitals with various non-liver disease related complaints (up to 30%) suggests a rise in the incidence of nosocomial HCV spread. HCV genotype 3a continues to be the most prevalent subtype infecting people in Pakistan (61.3%). However, recent years have witnessed an increase in the frequency of subtype 2a in certain geographical sub-regions within Pakistan. In Khyber Pakhtunkhwa and Sindh provinces, 2a was the second most prevalent genotype (17.3% and 11.3% respectively). While the changing frequency distribution of various genotypes demands an increased emphasis on research for novel therapeutic regimens, evidence of high nosocomial transmission calls for immediate measures aimed at ensuring safe medical practices.
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24
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Basazn Mekuria A, Melaku Gebresillassie B, Asfaw Erku D, Taye Haile K, Melese Birru E. Knowledge and Self-Reported Practice of Insulin Injection Device Disposal among Diabetes Patients in Gondar Town, Ethiopia: A Cross-Sectional Study. J Diabetes Res 2016; 2016:1897517. [PMID: 27738637 PMCID: PMC5055957 DOI: 10.1155/2016/1897517] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/28/2016] [Indexed: 12/13/2022] Open
Abstract
Background. Incorrect sharp disposal practices may expose the public to needle-stick injuries. The present study aimed at assessing the knowledge and practice of diabetic patients towards insulin injection device disposal in Gondar town, Ethiopia. Methods. A cross-sectional study was employed on insulin requiring diabetes patients who visited the diabetes clinic at Gondar University Referral Hospital (GURH) from February 1 to March 28, 2016. Frequencies, percentages, and ANOVA (analysis of variance) and Student's t-test were used to analyze variables. Results. About half of the participants (49.5%) had poor knowledge towards safe insulin injection waste disposal. More than two-thirds (80.7%) of respondents had poor practice and 64.3% of respondents did not put insulin needle and lancets into the household garbage. 31% of respondents threw sharps on street when they travel outside. Respondents living in urban areas had a higher mean of knowledge and practice score than those who live in rural area. Conclusions. This study revealed that knowledge and practice of diabetic patients were low towards safe insulin injection waste disposal in study area. Healthcare providers should also be aware of safe disposing system and counsel patients on appropriate disposal of used syringes.
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Affiliation(s)
- Abebe Basazn Mekuria
- Department of Pharmacology, College of Medicine and Health Sciences, University of Gondar, Chechela Street, Lideta Subcity Kebele 16, Gondar, Ethiopia
- *Abebe Basazn Mekuria:
| | - Begashaw Melaku Gebresillassie
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Chechela Street, Lideta Subcity Kebele 16, Gondar, Ethiopia
| | - Daniel Asfaw Erku
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Chechela Street, Lideta Subcity Kebele 16, Gondar, Ethiopia
| | - Kaleab Taye Haile
- Department of Pharmaceutics, School of Pharmacy, University of Gondar, Chechela Street, Lideta Subcity Kebele 16, Gondar, Ethiopia
| | - Eshetie Melese Birru
- Department of Pharmacology, College of Medicine and Health Sciences, University of Gondar, Chechela Street, Lideta Subcity Kebele 16, Gondar, Ethiopia
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25
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Sibley A, Han KH, Abourached A, Lesmana LA, Makara M, Jafri W, Salupere R, Assiri AM, Goldis A, Abaalkhail F, Abbas Z, Abdou A, Al Braiki F, Al Hosani F, Al Jaberi K, Al Khatry M, Al Mulla MA, Al Quraishi H, Al Rifai A, Al Serkal Y, Alam A, Alavian SM, Alashgar HI, Alawadhi S, Al-Dabal L, Aldins P, Alfaleh FZ, Alghamdi AS, Al-Hakeem R, Aljumah AA, Almessabi A, Alqutub AN, Alswat KA, Altraif I, Alzaabi M, Andrea N, Babatin MA, Baqir A, Barakat MT, Bergmann OM, Bizri AR, Blach S, Chaudhry A, Choi MS, Diab T, Djauzi S, El Hassan ES, El Khoury S, Estes C, Fakhry S, Farooqi JI, Fridjonsdottir H, Gani RA, Ghafoor Khan A, Gheorghe L, Gottfredsson M, Gregorcic S, Gunter J, Hajarizadeh B, Hamid S, Hasan I, Hashim A, Horvath G, Hunyady B, Husni R, Jeruma A, Jonasson JG, Karlsdottir B, Kim DY, Kim YS, Koutoubi Z, Liakina V, Lim YS, Löve A, Maimets M, Malekzadeh R, Matičič M, Memon MS, Merat S, Mokhbat JE, Mourad FH, Muljono DH, Nawaz A, Nugrahini N, Olafsson S, Priohutomo S, Qureshi H, Rassam P, Razavi H, Razavi-Shearer D, Razavi-Shearer K, Rozentale B, Sadik M, Saeed K, Salamat A, Sanai FM, Sanityoso Sulaiman A, Sayegh RA, Sharara AI, Siddiq M, Siddiqui AM, Sigmundsdottir G, Sigurdardottir B, Speiciene D, Sulaiman A, Sultan MA, Taha M, Tanaka J, Tarifi H, Tayyab G, Tolmane I, Ud Din M, Umar M, Valantinas J, Videčnik-Zorman J, Yaghi C, Yunihastuti E, Yusuf MA, Zuberi BF, Schmelzer JD. The present and future disease burden of hepatitis C virus infections with today's treatment paradigm - volume 3. J Viral Hepat 2015; 22 Suppl 4:21-41. [PMID: 26513446 DOI: 10.1111/jvh.12476] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/06/2015] [Indexed: 02/05/2023]
Abstract
The total number, morbidity and mortality attributed to viraemic hepatitis C virus (HCV) infections change over time making it difficult to compare reported estimates from different years. Models were developed for 15 countries to quantify and characterize the viraemic population and forecast the changes in the infected population and the corresponding disease burden from 2014 to 2030. With the exception of Iceland, Iran, Latvia and Pakistan, the total number of viraemic HCV infections is expected to decline from 2014 to 2030, but the associated morbidity and mortality are expected to increase in all countries except for Japan and South Korea. In the latter two countries, mortality due to an ageing population will drive down prevalence, morbidity and mortality. On the other hand, both countries have already experienced a rapid increase in HCV-related mortality and morbidity. HCV-related morbidity and mortality are projected to increase between 2014 and 2030 in all other countries as result of an ageing HCV-infected population. Thus, although the total number of HCV countries is expected to decline in most countries studied, the associated disease burden is expected to increase. The current treatment paradigm is inadequate if large reductions in HCV-related morbidity and mortality are to be achieved.
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Affiliation(s)
- A Sibley
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | - K H Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - A Abourached
- National Hepatitis Program, Ministry of Public Health, Beirut, Lebanon
| | - L A Lesmana
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.,Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia
| | - M Makara
- Central Outpatient Clinic, Saint Laszlo Hospital, Budapest, Hungary
| | - W Jafri
- Aga Khan University, Karachi, Pakistan
| | - R Salupere
- Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - A M Assiri
- Department of Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - A Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - F Abaalkhail
- Department of Liver and Small Bowel Transplantation, King Faisal Specialist Hospital and Research Centre, Alfaisal University, Riyadh, Saudi Arabia
| | - Z Abbas
- Ziauddin University, Karachi, Pakistan
| | - A Abdou
- Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | - F Al Braiki
- Abu Dhabi Health Services Company, Abu Dhabi, UAE
| | - F Al Hosani
- Communicable Diseases Department, Health Authority Abu Dhabi, Abu Dhabi, UAE
| | - K Al Jaberi
- Health Regulation Division, Health Authority Abu Dhabi, Abu Dhabi, UAE
| | - M Al Khatry
- Ras Al Khaimah Hospital, Ras Al Khaimah, UAE
| | - M A Al Mulla
- Communicable Diseases Department, Health Authority Abu Dhabi, Abu Dhabi, UAE
| | | | | | - Y Al Serkal
- Hospitals Sector, Ministry of Health, Abu Dhabi, UAE
| | - A Alam
- Shaikh Zayed Hospital, Lahore, Pakistan
| | - S M Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Tehran, Iran.,Middle East Liver Diseases Centre, Tehran, Tehran, Iran
| | - H I Alashgar
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - S Alawadhi
- Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | - L Al-Dabal
- Department of Pulmonary Medicine, Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | - P Aldins
- Infection Control Department, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - F Z Alfaleh
- Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - A S Alghamdi
- Gastroenterology and Hepatology Unit, Medical Specialties Department, King Fahad Hospital, Riyadh, Saudi Arabia
| | - R Al-Hakeem
- Department of Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - A A Aljumah
- King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A Almessabi
- Abu Dhabi Health Services Company, Abu Dhabi, UAE
| | - A N Alqutub
- Gastroenterology and Hepatology Unit, Medical Specialties Department, King Fahad Hospital, Riyadh, Saudi Arabia
| | - K A Alswat
- Department of Medicine, King Saud University Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - I Altraif
- King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - M Alzaabi
- Zayed Military Hospital, Abu Dhabi, UAE
| | - N Andrea
- Daman National Health Insurance Company, Abu Dhabi, UAE
| | - M A Babatin
- Gastroenterology and Hepatology Unit, Medical Specialties Department, King Fahad Hospital, Riyadh, Saudi Arabia
| | - A Baqir
- Seyal Medical Centre, Multan, Pakistan
| | | | - O M Bergmann
- Division of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - A R Bizri
- Division of Infectious Diseases, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Blach
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | - A Chaudhry
- Gujranwala Liver Foundation, Siddiq Sadiq Hospital, Gujranwala, Pakistan
| | - M S Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - T Diab
- Al Ain Hospital, Al Ain, UAE
| | - S Djauzi
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | | | - S El Khoury
- Gastroenterology Department, Saint George Hospital, University of Balamand, Beirut, Lebanon
| | - C Estes
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | - S Fakhry
- Abu Dhabi Police, Abu Dhabi, UAE
| | - J I Farooqi
- Postgraduate Medical Institute, Khyber Medical University, Peshawar, Pakistan.,Government Lady Reading Hospital, Peshawar, Pakistan
| | - H Fridjonsdottir
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - R A Gani
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - A Ghafoor Khan
- Department of Gastroenterology & Hepatology, Lady Reading Hospital, Peshawar, Pakistan
| | - L Gheorghe
- Center of Gastroenterology & Hepatology, Fundeni Clinical Institute, Bucharest, Romania
| | - M Gottfredsson
- Faculty of Medicine, School of Health Sciences, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - S Gregorcic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre, Ljubljana, Slovenia
| | - J Gunter
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | - B Hajarizadeh
- The Kirby Institute, University of New South Wales Australia, Sydney, NSW, Australia.,The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
| | - S Hamid
- The Aga Khan University, Karachi, Pakistan
| | - I Hasan
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - A Hashim
- Liver Transplantation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - G Horvath
- Hepatology Center of Buda, Budapest, Hungary
| | - B Hunyady
- Department of Gastroenterology, Somogy County Kaposi Mor Teaching Hospital, Kaposvar, Hungary.,First Department of Medicine, University of Pecs, Pecs, Hungary
| | - R Husni
- Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - A Jeruma
- Department of Hepatology, Infectology Center of Latvia, Riga, Latvia.,Department of Infectology and Dermatology, Riga Stradins University, Riga, Latvia
| | - J G Jonasson
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Icelandic Cancer Registry, Reykjavik, Iceland.,The Faculty of Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - B Karlsdottir
- Division of Infectious Disease, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - D Y Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Y S Kim
- Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Z Koutoubi
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - V Liakina
- Centre of Hepatology, Gastroenterology, and Dietetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Biomechanics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Y S Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - A Löve
- Faculty of Medicine, School of Health Sciences, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Department of Virology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - M Maimets
- Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - R Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - M Matičič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre, Ljubljana, Slovenia
| | - M S Memon
- Asian Institute of Medical Science (AIMS), Hyderabad, Sindh, Pakistan
| | - S Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - J E Mokhbat
- Divisions of Infectious Diseases and Clinical Microbiology, Lebanese American University Medical Center Rizk Hospital, Beirut, Lebanon
| | - F H Mourad
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - D H Muljono
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia.,Department of Hepatitis & Emerging Infectious Diseases, University of Sydney, Sydney, NSW, Australia
| | - A Nawaz
- Department of Gastroenterology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
| | - N Nugrahini
- Sub-Directorate for Gastrointestinal Infection, Diarrheal Diseases, and Hepatitis, Directorate of Direct Transmitted Disease Control, Disease Control & Environmental Health, Ministry of Health, Jakarta, Indonesia
| | - S Olafsson
- Division of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - S Priohutomo
- Directorate of Direct Transmitted Disease Control, Disease Control & Environmental Health, Ministry of Health, Jakarta, Indonesia
| | - H Qureshi
- Pakistan Medical Research Council, Islamabad, Pakistan
| | - P Rassam
- Gastroenterology Department, Saint George Hospital, University of Balamand, Beirut, Lebanon
| | - H Razavi
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | | | | | - B Rozentale
- Department of Hepatology, Infectology Center of Latvia, Riga, Latvia.,Department of Infectology and Dermatology, Riga Stradins University, Riga, Latvia
| | - M Sadik
- Asian Institute of Medical Science (AIMS), Hyderabad, Sindh, Pakistan
| | - K Saeed
- Khawar Clinic, Sahiwal, Pakistan
| | - A Salamat
- Department of Gastroenterology, Military Hospital, Rawalpindi, Pakistan
| | - F M Sanai
- Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - A Sanityoso Sulaiman
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - R A Sayegh
- Department of Hepatology and Gastroenterology, School of Medical Science, Saint Joseph University, Beirut, Lebanon
| | - A I Sharara
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Siddiq
- Jinnah Memorial Hospital, Rawalpindi, Pakistan.,Yusra Medical College, Rawalpindi, Pakistan
| | | | - G Sigmundsdottir
- Centre for Health Security and Communicable Disease Control, Directorate of Health in Iceland, Reykjavik, Iceland
| | - B Sigurdardottir
- Division of Infectious Disease, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - D Speiciene
- Centre of Hepatology, Gastroenterology, and Dietetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A Sulaiman
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.,Klinik Hati Prof. Ali Sulaiman, Jakarta, Indonesia
| | - M A Sultan
- Health Funding Department, Enaya Insurance Company, Abu Dhabi, UAE
| | - M Taha
- Department of Medicine, Tawam Hospital, Al Ain, UAE
| | - J Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - H Tarifi
- Pharmacy Department, Tawam Hospital, Al Ain, UAE
| | - G Tayyab
- Postgraduate Medical Institute, Lahore General Hospital, Lahore, Pakistan.,Doctors Hospital and Medical Center, Lahore, Pakistan
| | - I Tolmane
- Department of Hepatology, Infectology Center of Latvia, Riga, Latvia.,Department of Infectology and Dermatology, Riga Stradins University, Riga, Latvia
| | - M Ud Din
- Pakistan Society of Gastroenterology, Karachi, Pakistan
| | - M Umar
- Department of Medicine, Rawalpindi Medical College, Rawalpindi, Pakistan.,Department of Medicine, Holy Family Hospital, Rawalpindi, Pakistan
| | - J Valantinas
- Centre of Hepatology, Gastroenterology, and Dietetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - J Videčnik-Zorman
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre, Ljubljana, Slovenia
| | - C Yaghi
- Department of Hepatology and Gastroenterology, School of Medical Science, Saint Joseph University, Beirut, Lebanon
| | - E Yunihastuti
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - M A Yusuf
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | | | - J D Schmelzer
- Center for Disease Analysis (CDA), Louisville, CO, USA
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Choo MKK, El-Bassel N, Adam PCG, Gilbert L, Wu E, West BS, Bazazi AR, De Wit JBF, Ismail R, Kamarulzaman A. Prevalence and Correlates of HIV and Hepatitis C Virus Infections and Risk Behaviors among Malaysian Fishermen. PLoS One 2015; 10:e0118422. [PMID: 26244844 PMCID: PMC4526636 DOI: 10.1371/journal.pone.0118422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 01/06/2015] [Indexed: 02/05/2023] Open
Abstract
Fishermen in Southeast Asia have been found to be highly vulnerable to HIV, with research evidence highlighting the role of sexual risk behaviors. This study aims to estimate the rate of HIV as well as hepatitis C virus (HCV) infections among Malaysian fishermen, and the risky sexual and injection drug use behaviors that may contribute to these infections. The study also includes an assessment of socio-demographic, occupational and behavioral correlates of testing positive for HIV or HCV, and socio-demographic and occupational correlates of risk behaviors. The study had a cross-sectional design and recruited 406 fishermen through respondent-driven sampling (RDS). Participants self-completed a questionnaire and provided biological specimens for HIV and HCV testing. We conducted and compared results of analyses of both unweighted data and data weighted with the Respondent-Driven Sampling Analysis Tool (RDSAT). Of the participating fishermen, 12.4% were HIV positive and 48.6% had HCV infection. Contrary to expectations and findings from previous research, most fishermen (77.1%) were not sexually active. More than a third had a history of injection drug use, which often occurred during fishing trips on commercial vessels and during longer stays at sea. Of the fishermen who injected drugs, 42.5% reported unsafe injection practices in the past month. Reporting a history of injection drug use increased the odds of testing HIV positive by more than 6 times (AOR = 6.22, 95% CIs [2.74, 14.13]). Most fishermen who injected drugs tested positive for HCV. HCV infection was significantly associated with injection drug use, being older than 25 years, working on a commercial vessel and spending four or more days at sea per fishing trip. There is an urgent need to strengthen current harm reduction and drug treatment programs for Malaysian fishermen who inject drugs, especially among fishermen who work on commercial vessels and engage in deep-sea fishing.
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Affiliation(s)
- Martin K. K. Choo
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, New York, United States of America
| | - Philippe C. G. Adam
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, UNSW Australia, Sydney, Australia
| | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, New York, New York, United States of America
| | - Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, New York, New York, United States of America
| | - Brooke S. West
- Social Intervention Group, Columbia University School of Social Work, New York, New York, United States of America
| | - Alexander R. Bazazi
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - John B. F. De Wit
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, UNSW Australia, Sydney, Australia
| | - Rusli Ismail
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Omata M, Kanda T, Yokosuka O, Crawford D, Al-Mahtab M, Wei L, Ibrahim A, Lau GKK, Sharma BC, Hamid SS, Chuang WL, Dokmeci AK. Features of hepatitis C virus infection, current therapies and ongoing clinical trials in ten Asian Pacific countries. Hepatol Int 2015; 9:486-507. [PMID: 25941137 DOI: 10.1007/s12072-015-9630-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/06/2015] [Indexed: 02/07/2023]
Abstract
Estimated hepatitis C virus (HCV) infection rates in the general populations were 1.3, 0.9, 0.4-1.0, 14.7, 0.1-0.3, 0.9-1.9, 1.0-2.0, 5, 4.4-8.6 and 0.5-1.3 % in Australia, Bangladesh, Mainland China, Egypt, Hong Kong, India, Japan, Pakistan, Taiwan and Turkey, respectively. The main HCV genotypes (Gs) are G1, G3, G1b, G4, G1b, G3, G1b, G3, G1b and G2, and G1 in Australia, Bangladesh, Mainland China, Egypt, Hong Kong, India, Japan, Pakistan, Taiwan and Turkey, respectively. Of IL28B genotypes, favorable alleles are ~50 % in Australia and Turkey, but 60-70 % in most of the other Asian countries. Peginterferon plus ribavirin is available in all ten Asian Pasific countries. In addition, HCV NS3/4A protease inhibitors with peginterferon plus ribavirin are currently available in several countries. Clinical trials of interferon-free regimens for HCV are ongoing in most of the ten Asian Pacific countries.
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Affiliation(s)
- Masao Omata
- Yamanashi Hospitals (Central and Kita) Organization, 1-1-1 Fujimi, Kofu-shi, Yamanashi, 400-8506, Japan. .,University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tatsuo Kanda
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Darrell Crawford
- University of Queensland, School of Medicine, Woolloongabba, QLD, 4102, Australia.
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh.
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China.
| | - Alaaeldin Ibrahim
- GI/Liver Division, Department of Internal Medicine, University of Benha, Benha, Egypt.
| | - George K K Lau
- Humanity and Health Medical Centre, Hong Kong SAR China Institute of Translational Hepatology and Centre of Liver Fibrosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China.
| | - Barjesh C Sharma
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
| | - Saeed S Hamid
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan.
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
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Kim KA, Jeong SH, Jang ES, Kim YS, Lee YJ, Jung EU, Kim IH, Cho SB, Kee MK, Kang C. Geographic differences in the epidemiological features of HCV infection in Korea. Clin Mol Hepatol 2014; 20:361-7. [PMID: 25548742 PMCID: PMC4278067 DOI: 10.3350/cmh.2014.20.4.361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 11/21/2014] [Accepted: 11/26/2014] [Indexed: 11/08/2022] Open
Abstract
Background/Aims The prevalence of hepatitis C virus (HCV) infection in Korea exhibits significant geographic variation, with it being higher in Busan and Jeonam than in other areas. The reason for this intranational geographic difference was investigated in this study by conducting a comparative analysis of the risk factors related to HCV infection among three geographic areas: the capital (Seoul), Busan, and the province of Jeolla. Methods In total, 990 patients with chronic HCV infection were prospectively enrolled at 5 university hospitals located in Seoul (n=374), Busan (n=264), and Jeolla (n=352). A standardized questionnaire survey on the risk factors for HCV infection was administered to these three groups of patients, and a comparative analysis of the findings was performed. Results The analysis revealed significant regional differences in exposure to the risk factors of HCV infection. By comparison with patients in Seoul as a control group in the multivariate analysis, patients in Busan had significantly more experience of invasive medical procedures, acupuncture, cosmetic procedures, and multiple sex partners. In contrast, patients in Jeolla were significantly older, and they had a higher prevalence of hepatocellular carcinoma, a lower prevalence of multiple sex partners, and had experienced fewer invasive procedures. Conclusions There was a significant geographic difference in the exposure to potential risk factors of HCV infection between patients from the three studied regions. This may explain the regional variation of the prevalence of HCV infection in Korea, and should be taken into account when planning strategies for the prevention and management of HCV infection.
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Affiliation(s)
- Kyung-Ah Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Youn Jae Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Eun Uk Jung
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - In Hee Kim
- Department of Internal Medicine, Chonbuk National University, Jeonju, Korea
| | - Sung Bum Cho
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Mee-Kyung Kee
- Division of AIDS, Korea National Institute of Health, Osong, Korea
| | - Chun Kang
- Division of AIDS, Korea National Institute of Health, Osong, Korea
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Janjua NZ, Mahmood B, Imran Khan M. Does knowledge about bloodborne pathogens influence the reuse of medical injection syringes among women in Pakistan? J Infect Public Health 2014; 7:345-55. [PMID: 24861642 DOI: 10.1016/j.jiph.2014.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 12/12/2022] Open
Abstract
Injections with re-used syringes have been identified as a major risk factor for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in Pakistan. We analyzed data from the 2006-2007 Pakistan Demographic Health Survey (PDHS) to describe the distribution of injections administered with newly opened syringes and assessed the association of knowledge about bloodborne pathogens with syringe reuse in Pakistan. In the PDHS, women aged 12-49 years were enrolled through a multistage stratified cluster-sampling strategy across Pakistan. Approximately 10,000 women were interviewed to collect information regarding receiving injections, the use of syringes taken out of new unopened packages for their last injections, and knowledge regarding the transmission of Human Immunodeficiency Virus (HIV), HBV and HCV through the re-use of syringes and transfusion of unscreened blood. Of the 5126/10,023 women who provided information concerning their last injection, 4342 (86%) received this injection with a new syringe taken out of an unopened package. The proportion of injections received with a new syringe increased with the education level, wealth, HIV knowledge and knowledge about HCV/HBV transmission through the re-use of syringes. In the multivariable model, respondents in the 4th (adjusted odds ratio (AOR): 2.1, 95%CI: 1.4-3.0) and 5th (AOR: 2.4, 95%CI: 1.6-3.5) wealth quintiles, with some education (AOR: 1.4, 95%CI: 1.1-1.9), those in the 4th quartile of the HIV knowledge score (AOR: 1.5, 95%CI: 1.1-2.0), and those with the knowledge that a new syringe protects against HCV/HBV and HIV (AOR: 2.3, 95%CI: 1.5-3.5) were more likely to receive injections with a newly opened syringe. The patients' knowledge regarding the transmission of bloodborne pathogens is an important factor in receiving injections with a new syringe.
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Affiliation(s)
- Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Schools of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | | | - M Imran Khan
- Department of International Health, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, United States
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30
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O'Leary MC, Sarwar M, Hutchinson SJ, Weir A, Schofield J, McLeod A, Cameron S, McTaggart C, Banday S, Foster GR, Ahmed S, Fox R, Mills PR, Goldberg DJ, Anderson E. The prevalence of hepatitis C virus among people of South Asian origin in Glasgow – Results from a community based survey and laboratory surveillance. Travel Med Infect Dis 2013; 11:301-9. [DOI: 10.1016/j.tmaid.2013.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 08/10/2013] [Accepted: 08/13/2013] [Indexed: 01/22/2023]
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Altaf A, Shah SA, Shaikh K, Constable FM, Khamassi S. Lessons learned from a community based intervention to improve injection safety in Pakistan. BMC Res Notes 2013; 6:159. [PMID: 23607289 PMCID: PMC3637594 DOI: 10.1186/1756-0500-6-159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 04/18/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND A national study in 2007 revealed that in Pakistan the prevalence of hepatitis B is 2.5% and for hepatitis C it is 5%. Unsafe injections have been identified as one of the reasons for the spread of these infections. Trained and untrained providers routinely perform unsafe practices primarily for economic reasons i.e. they reuse injection equipment on several patients. The patients, do not question the provider about the need for an injection because of social barriers or whether the syringe is coming from a new sterile packet due to lack of knowledge. The present paper represents an intervention that was developed to empower the community to improve unsafe injection practices in rural Pakistan. METHODS In a rural district of Pakistan (Tando Allahyar, Sindh) with a population of approximately 630,000 a multipronged approach was used in 2010 (June to December) to improve injection safety. The focus of the intervention was the community, however providers were not precluded. The organization of interventions was also carefully planned. A baseline assessment (n=300) was conducted prior to the intervention. The interventions comprised large scale gatherings of the community (males and females) across the district. Smaller gatherings included teachers, imams of mosques and the training of trained and untrained healthcare providers. The Pakistan Television Network was used to broadcast messages recorded by prominent figures in the local language. The local FM channel and Sunday newspaper were also used to disseminate messages on injection safety. An end of project assessment was carried out in January 2012. The study was ethically reviewed and approved. RESULTS The interventions resulted in improving misconceptions about transmission of hepatitis B and C. In the baseline assessment (only 9%) of the respondents associated hepatitis B and C with unsafe injections which increased to 78% at the end of project study. In the baseline study 15% of the study participants reported that a new syringe was used for their most recent injection. The post-intervention findings showed an increase to 29% (n=87). CONCLUSION It is difficult to assess the long-term impact of the intervention but there were several positive indicators. The duration of intervention is the key to achieving a meaningful impact. It has to be at least 18-24 months long.
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Affiliation(s)
- Arshad Altaf
- Bridge Consultants Foundation, 4-E, Block-6, PECHS, Off Sharahe-e-Faisal, Karachi 74500, Pakistan.
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Yousafzai MT, Siddiqui AR, Janjua NZ. Health belief model to predict sharps injuries among health care workers at first level care facilities in rural Pakistan. Am J Ind Med 2013; 56:479-87. [PMID: 22996806 DOI: 10.1002/ajim.22117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND We assessed the frequency and predictors of sharp injuries (SIs) among health care workers (HCWs) at first level care facilities (FLCF) in rural Pakistan. METHOD HCWs working at public clinic (PC), privately owned licensed practitioners' clinic (LPC) and non-licensed practitioners' clinic(NLC) were interviewed on universal precautions (UPs) and constructs of health belief model (HBM) to assess their association with SIs through negative-binomial regression. RESULTS From 365 clinics, 485 HCWs were interviewed. Overall annual rate of SIs was 192/100 HCWs/year; 78/100 HCWs among licensed prescribers, 191/100 HCWs among non-licensed prescribers, 248/100 HCWs among qualified assistants, and 321/100 HCWs among non-qualified assistants. Increasing knowledge score about bloodborne pathogens (BBPs) transmission (rate-ratio (RR): 0.93; 95%CI: 0.89-0.96), fewer years of work experience, being a non-licensed prescriber (RR: 2.02; 95%CI: 1.36-2.98) licensed (RR: 2.86; 9%CI: 1.81-4.51) or non-licensed assistant (RR: 2.78; 95%CI: 1.72-4.47) compared to a licensed prescriber, perceived barriers (RR: 1.06; 95%CI: 1.03-1.08), and compliance with UPs scores (RR: 0.93; 95%CI: 0.87-0.97) were significant predictors of SIs. CONCLUSION Improved knowledge about BBPs, compliance with UPs and reduced barriers to follow UPs could reduce SIs to HCWs.
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Ahmed B, Ali T, Qureshi H, Hamid S. Population-attributable estimates for risk factors associated with hepatitis B and C: policy implications for Pakistan and other South Asian countries. Hepatol Int 2013. [PMID: 26201782 DOI: 10.1007/s12072-012-9417-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Reuse of contaminated syringes, high frequency of injections, tattooing and skin piercing have repeatedly been shown to be important and independent risk factors for the transmission of hepatitis B (HBV) and C (HCV) infections in South Asian countries. Estimation of population-attributable risks indicates the potential for hepatitis prevention if the exposure to certain modifiable factors can be eliminated. METHODS We estimated the population-attributable risks of various risk factors for transmission of HBV and HCV using data from a large, nationally representative survey conducted in 2007 across Pakistan, a country known to have a high prevalence of chronic viral hepatitis. Odds ratio estimates and observed prevalence of the risk factors were used for calculating PAR estimates. We also performed a systematic review of published studies that identify the prevalence of similar modifiable risk factors for HBV and HCV from other South Asian countries in order to define an overall prevention strategy for the region. RESULTS For HBV, a high frequency (>10) of therapeutic injections in the past 1 year had an attributable risk of 3.5 % (95 % CI 2.9-3.9), reuse of syringes had a 2.7 % risk (95 % CI 2.2-3.1), the practice of being shaved by a barber 2.1 % (95 % CI 1.7-2.6), sharing of smoking utensils 4.4 % (95 % CI 3.8-4.9) and ear/nose piercing 1.4 % (95 % CI 1.2-1.7). Population-attributable risks for HCV were as follows: high frequency of therapeutic injections in the past 1 year 11.3 % (95 % CI 10.5-11.7), reuse of syringes 6.2 % (95 % CI 6.1-6.9), practice of being shaved by a barber shop 7.9 % (95 % CI 7.1-8.2), sharing of smoking utensils 8.1 % (95 % CI 6.9-8.5), practice of ear/nose piercing among females 5.9 % (95 % CI 5.2-6.1) and tattooing 5 % (95 % CI 4.3-5.6). A systematic review showed that other South Asian countries share a number of common risk factors for the transmission of viral hepatitis. CONCLUSION A substantial number of HBV and HCV infections in Pakistan and other South Asian countries can be prevented by key interventions targeted toward a few selected and modifiable risk factors. Hence, policies specifically targeted at key risk factors for HBV and HCV such as safe and rational use of injections prescribed by trained health-care providers are urgently needed for countries like Pakistan.
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Affiliation(s)
- Bilal Ahmed
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Tooba Ali
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Huma Qureshi
- Pakistan Medical and Research Council, Islamabad, Pakistan
| | - Saeed Hamid
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan.
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Persisting role of healthcare settings in hepatitis C transmission in Pakistan: cause for concern. Epidemiol Infect 2012; 141:1831-9. [DOI: 10.1017/s0950268812002312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYTransmission of hepatitis C (HCV) in Pakistan is a continuing public health problem; 15 years ago it was linked to the practice of reusing therapeutic instruments in healthcare settings. We sought to examine current risk factors for HCV transmission in a hospital population in Karachi, Pakistan. We enrolled 300 laboratory-confirmed HCV-positive participants and 300 laboratory-confirmed HCV-negative participants from clinics at Indus Hospital. Independent and significant risk factors for both men and women were: receiving ⩾12 injections in the past year, blood transfusions, having had dental work performed, and delivery in hospital or transfusion for women. Interestingly, being of Mohajir origin or born in Sindh province were protective. Encouragingly, a strong protective effect was observed for those that reported bringing their own needle for injections (59%). The widespread reuse of therapeutic needles in healthcare settings in Karachi remains a major driver of the HCV epidemic.
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Reid S. Estimating the Burden of Disease from Unsafe Injections in India: A Cost-benefit Assessment of the Auto-disable Syringe in a Country with Low Blood-borne Virus Prevalence. Indian J Community Med 2012; 37:89-94. [PMID: 22654281 PMCID: PMC3361807 DOI: 10.4103/0970-0218.96093] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 09/18/2011] [Indexed: 02/06/2023] Open
Abstract
Background: Unsafe medical injections are a prevalent risk factor for viral hepatitis and HIV in India. Objectives: This review undertakes a cost–benefit assessment of the auto-disable syringe, now being introduced to prevent the spread of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV). Materials and Methods: The World Health Organization methods for modeling the global burden of disease from unsafe medical injections are reproduced, correcting for the concentrated structure of the HIV epidemic in India. A systematic review of risk factor analyses in India that investigate injection risks is used in the uncertainty analysis. Results: The median population attributable fraction for hepatitis B carriage associated with recent injections is 46%, the median fraction of hepatitis C infections attributed to unsafe medical injections is 38%, and the median fraction of incident HIV infections attributed to medical injections is 12% in India. The modeled incidence of blood-borne viruses suggests that introducing the auto-disable syringe will impose an incremental cost of $46–48 per disability adjusted life year (DALY) averted. The epidemiological evidence suggests that the incremental cost of introducing the auto-disable syringe for all medical injections is between $39 and $79 per DALY averted. Conclusions: The auto-disable syringe is a cost-effective alternative to the reuse of syringes in a country with low prevalence of blood-borne viruses.
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Affiliation(s)
- Savanna Reid
- School of Community Health Sciences, University of Nevada at Las Vegas, 4505 Maryland Parkway, Las Vegas, NV, USA
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36
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Ishtiaq O, Qadri AM, Mehar S, Gondal GM, Iqbal T, Ali S, Janjua NZ. Disposal of syringes, needles, and lancets used by diabetic patients in Pakistan. J Infect Public Health 2012; 5:182-8. [PMID: 22541266 DOI: 10.1016/j.jiph.2012.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 02/10/2012] [Accepted: 02/16/2012] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the use, handling and disposal of insulin injection equipment by diabetic patients in Pakistan. METHODS We conducted a cross-sectional study at diabetic clinics in five tertiary centers in Pakistan. All diabetic patients (type 1/type 2) who were on insulin for more than 1 month, were included. An Urdu (local language)-translated questionnaire was used to collect information on insulin administration equipment, the site and frequency of needle use, insulin syringe/pen/lancet disposal, sharing of needles and knowledge about diseases that are spread by sharing contaminated needles. RESULTS Of 375 patients, 58% were female. The mean (SD) duration of diabetes was 12.3 (7.3) years, and the duration of insulin use was 4.4 (4.3) years. The majority of the patients used syringes (88.3%) for insulin administration. Additionally, the majority of the patients disposed of used devices (syringes, 92%; pens, 75%; and lancets, 91%) in the household garbage collection bin. About half of the patients (n=185) reported being educated by their physicians about the disposal of sharps. Those who were educated by a physician (adjusted odds ratio (adjOR): 0.36; 95%CI: 0.16-0.81) or could read/write English (adjOR: 0.32; 95%CI: 0.11-0.92) were less likely to dispose of syringes and needles in the household garbage. CONCLUSION The common disposal of sharps in the household garbage has implications for disease transmission. Education on the safe disposal of sharps may improve the disposal practices.
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Response to antiviral therapy in patients with genotype 3 chronic hepatitis C: fibrosis but not race encourages relapse. Eur J Gastroenterol Hepatol 2011; 23:747-53. [PMID: 21691208 DOI: 10.1097/meg.0b013e3283488aba] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS We completed a retrospective analysis of patients with genotype 3 hepatitis C virus (HCV) undergoing therapy in four UK centres with large populations of patients from the Indian subcontinent. MATERIALS AND METHODS Notes on all patients treated with pegylated interferon and ribavirin were reviewed and factors that influenced the response were examined. RESULTS Six hundred and four patients with genotype 3 HCV were studied, of whom 299 were Asians. Median age was 43 years, 65% were men and 24% had cirrhosis. Overall, 457 (76%) patients achieved sustained virological response (SVR). By multivariable analysis it was found that ethnicity was not associated with an impaired response but age, cirrhosis and diabetes were significantly associated with a reduced SVR, the likelihood of a response was reduced by 25% per 10-year increment in age, by 59% among individuals with cirrhosis and by 62% among individuals with diabetes mellitus. Most patients who did not achieve an SVR relapsed (15%) rather than failing to achieve an end of treatment response. CONCLUSION The response to antiviral therapy in genotype 3 HCV is not affected by South Asian (vs. Caucasian) ethnicity, but age, cirrhosis and diabetes reduce the response. Treatment failure most often is due to relapse.
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The effectiveness of outreach testing for hepatitis C in an immigrant Pakistani population. Epidemiol Infect 2011; 140:1048-53. [DOI: 10.1017/s095026881100152x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
SUMMARYIn Scotland, an estimated 1% of the population is infected with hepatitis C virus (HCV). There is ethnic diversity in Scotland, with a large Pakistani sub-population. Our aim was to investigate the prevalence of HCV in an immigrant Pakistani population and effectiveness of an outreach testing intervention. We arranged a series of HCV awareness meetings at the mosques and Pakistani Women's centre in the city of Dundee. Thereafter short-term outreach HCV testing clinics were set up in the same venues. Venous blood samples were obtained and tested for HCV IgG and HbsAg. A short questionnaire was also completed. In total, 177 individuals volunteered for testing, out of an estimated 250 who attended meetings and a total Pakistani population in Dundee of 1723. Of those tested 170 were Scottish Pakistanis (159 first generation, 11 second generation). There were 145 (85·2%) men. The mean age was 45·11 (±s.d. 16·7) years. Seven (4·1%) individuals in the cohort were anti-HCV positive. Five (2·9%) were found to have HCV RNA by PCR. Only one patient had chronic hepatitis B infection. All patients with positive results were seen in the liver clinic for consideration of treatment. We have demonstrated that immigrant Pakistanis retain a higher prevalence of HCV compared to the population of their adopted country. Outreach targeted testing in this group can be achieved using religious and cultural gatherings, with only modest investment in staff time.
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Janjua NZ, Khan MI, Mahmood B. Sharp injuries and their determinants among health care workers at first-level care facilities in Sindh Province, Pakistan. Trop Med Int Health 2010; 15:1244-51. [DOI: 10.1111/j.1365-3156.2010.02610.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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