The epidemiology of hepatitis C virus in Afghanistan: systematic review and meta-analysis

• HCV prevalence is at around 1% among the population at large in Afghanistan.
• HCV prevalence among people who inject drugs is substantial and varies by region.
• Genotype 3 appears to be the dominant genotype among people who inject drugs.
• HCV epidemiology among clinical populations at high risk remains unknown.

SummaryObjectivesTo characterize hepatitis C virus (HCV) epidemiology and inform public health research, policy, and programming priorities in Afghanistan.MethodsRecords of HCV incidence and prevalence were reviewed systematically and synthesized following PRISMA guidelines. Meta-analyses were implemented using a DerSimonian–Laird random effects model with inverse variance weighting to estimate HCV prevalence among various at risk populations. A risk of bias assessment was incorporated.ResultsThe search identified one HCV incidence and 76 HCV prevalence measures. HCV incidence was only assessed among people who inject drugs (PWID), and was reported at 66.7 per 100 person-years. Meta-analyses estimated HCV prevalence at 0.7% among the general population (range 0–9.1%, 95% confidence interval (CI) 0.5–0.9%), 32.6% among PWID (range 9.5–70.0%, 95% CI 24.5–41.3%), and 2.3% among populations at intermediate risk (range 0.0–8.3%, 95% CI 1.3–3.7%). No data were available for other high risk populations such as hemodialysis, thalassemia, and hemophilia patients.ConclusionsHCV prevalence among the general population in Afghanistan is comparable to global levels. Data are needed for the level of infection among key clinical populations at high risk of infection. There is also an immediate need for expansion of harm reduction programs among PWID and prisoners.