Estimating the prevalence of hepatitis C among intravenous drug users in upper middle income countries: A systematic review and meta-analysis

AimThis systematic review and meta-analysis characterizes the prevalence of hepatitis C virus (HCV) infection among intravenous drug users (IDUs) in upper middle-income countries.MethodsFive databases were searched from 1990–2016 for studies that took place in countries with a GDP per capita of $7,000 to $13,000 USD. The data extraction was performed based on information regarding prevalence, sample size, age of participants, duration of intravenous drug use (IDU), recruitment location, dates of data collection, study design, sampling scheme, type of tests used in identifying antibody reactivity to HCV, and the use of confirmatory tests. The synthesis was performed with a random effects model. The Cochrane statistical Q-test was used to evaluate the statistical heterogeneity of the results.ResultsThe 33 studies included in the analysis correspond to a sample of seven countries and 23,342 observations. The point prevalence value estimates and confidence intervals of the random effects model were 0.729 and 0.644–0.800, respectively for all seven countries, and were greatest for China (0.633; 0.522–0.732) as compared to Brazil (0.396; 0.249–0.564). Prevalence for Montenegro (0.416; 0.237–0.621) and Malaysia (0.475; 0.177–0.792) appear to be intermediate. Mexico (0.960) and Mauritania (0.973) had only one study with the largest prevalence. A clear association was not observed between age or duration of IDU and prevalence of HCV, but the data from some groups may indicate a possible relationship. The measures of heterogeneity (Q and I2) suggest a high level of heterogeneity in studies conducted at the country level and by groups of countries.ConclusionsIn this systematic review and meta-analysis, we found that the pooled prevalence of HCV was high (0.729) among a group of seven upper middle income countries. However, there was significant variation in the prevalence of HCV observed in China (0.633) and Brazil (0.396).

目的 本系统综述与荟萃分析旨在阐明上中等收入国家静脉注射毒品使用者（intravenous drug users, IDUs）中丙型肝炎病毒（hepatitis C virus, HCV）感染的流行情况。方法 本研究检索了1990年至2016年间5个数据库中，针对人均国内生产总值（Gross Domestic Product, GDP）为7000至13000美元的国家开展的相关研究。数据提取基于以下信息：流行率、样本量、参与者年龄、静脉注射毒品使用时长、招募地点、数据收集日期、研究设计、抽样方案、用于检测HCV抗体反应性的检测方法类型，以及确证试验的使用情况。荟萃分析采用随机效应模型进行合并分析，并使用Cochrane统计学Q检验评估结果的统计异质性。结果 本分析纳入的33项研究覆盖7个国家，共计23342例观察对象。针对全部7个国家的随机效应模型合并点流行率估计值及其置信区间分别为0.729与0.644~0.800；其中中国的流行率为0.633（95%置信区间：0.522~0.732），高于巴西的0.396（0.249~0.564）。黑山（0.416；0.237~0.621）与马来西亚（0.475；0.177~0.792）的HCV流行率处于中等水平。墨西哥（0.960）与毛里塔尼亚（0.973）仅各有1项相关研究，其HCV流行率为所有纳入研究中最高。未观察到年龄或静脉注射毒品使用时长与HCV流行率存在明确关联，但部分亚组数据提示二者可能存在潜在联系。异质性指标（Q值与I²值）显示，各国及各国家组开展的研究间存在较高水平的统计异质性。结论 本系统综述与荟萃分析结果显示，纳入分析的7个上中等收入国家中，HCV合并流行率较高（0.729）。但中国（0.633）与巴西（0.396）的HCV流行率存在显著差异。