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Background and Aims: Although the evidence is uncertain, existing estimates for hepatitis C virus (HCV) in sub‐Saharan Africa (SSA) indicate a high burden. We estimated HCV seroprevalence and viraemic prevalence among the general population in SSA. Methods: We searched Medline, Embase, Web of Science, APA PsycINFO, and World Health Organization Africa Index Medicus for community‐based studies. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool, and heterogeneity using the index of heterogeneity (I2). Two approaches were deployed. First, we used random‐effects meta‐analysis to pool prevalence. Second, to derive representative estimates, we weighted each country's HCV seroprevalence using 2021 United Nations country population sizes. Results: We synthesized 130 studies. Overall, SSA HCV seroprevalence from the random‐effects model was 4.17% (95% confidence interval [CI]: 3.71–4.66, I2 = 99.30%). There were no differences between males (4.31%) and females (4.03%). Seroprevalence was 2.25%, 3.31%, and 16.23% for ages ≤20, 21–64, and ≥65 years, respectively, and was higher in rural (6.63%) versus urban (2.93%). There was indication of decrement overtime from 5.74% to 4.35% to 3.03% in the years 1984–2000, 2001–2014, and 2015–2023, respectively. The weighted overall SSA HCV seroprevalence was estimated to be 2.30% (95% CI: 1.59–3.00) with regional variation: Africa‐Southern (.79%), Africa‐Central (1.47%), Africa‐Eastern (2.71%), and Africa‐Western (2.88%). HCV viremia among HCV seropositives was 54.77% (95% CI: 47.80–61.66). Conclusions: HCV seroprevalence in SSA remains high. Populations aged ≥65 years, rural communities, Africa‐Western, and some countries in Africa‐Central and Africa‐Eastern appear disproportionately affected. These results underline the need for governmental commitment to achieve the 2030 global HCV elimination targets. [ABSTRACT FROM AUTHOR]

To date, studies examining HCV treatment outcomes among PWID using DAA therapy have been conducted predominantly in higher income settings. Individuals who had a detectable HCV viral load at post-treatment week 12 or those who were missing an HCV viral load at post-treatment week 12 were classified as a treatment failure. Keywords: Africa; DAA; HCV; LMIC; PWID EN Africa DAA HCV LMIC PWID 691 694 4 07/13/22 20220801 NES 220801 Abbreviations APRI Aspartate Aminotransferase to Platelet Ratio Index CTP Child-Turcotte-Pugh DAA Direct-acting antivirals DOT Directly observed therapy FIB-4 Fibrosis-4 HBV Hepatitis B virus HCV Hepatitis C virus KSH Kenyan shilling LDV Ledipasvir LMICs Low- and middle-income countries MAT Medication-assisted treatment NSP Needle and syringe programmes PCM Peer case manager PWID People who inject drugs SOF Sofosbuvir SSA Sub-Saharan Africa SVR Sustained virologic response INTRODUCTION Although between 10 and 15 million of the estimated 71 million people worldwide living with the hepatitis C virus (HCV) live in sub-Saharan Africa (SSA),1 recent data suggest only 1% of these individuals have accessed HCV treatment.1 Diminished access has been attributed to the financial and geographical barriers to general medical care, and limited regional availability of direct-acting antivirals (DAA). [Extracted from the article]

The World Health Organization (WHO) recently produced guidelines advising a treat‐all policy for HCV to encourage widespread treatment scale‐up for achieving HCV elimination. We modelled the prevention impact achieved (HCV infections averted [IA]) from initiating this policy compared with treating different subgroups at country, regional and global levels. We assessed what country‐level factors affect impact. A dynamic, deterministic HCV transmission model was calibrated to data from global systematic reviews and UN data sets to simulate country‐level HCV epidemics with ongoing levels of treatment. For each country, the model projected the prevention impact (in HCV IA per treatment undertaken) of initiating four treatment strategies; either selected randomly (treat‐all) or targeted among people who inject drugs (PWID), people aged ≥35, or those with cirrhosis. The IA was assessed over 20 years. Linear regression was used to identify associations between IA per treatment and demographic factors. Eighty‐eight countries (85% of the global population) were modelled. Globally, the model estimated 0.35 (95% credibility interval [95%CrI]: 0.16‐0.61) IA over 20 years for every randomly allocated treatment, 0.30 (95%CrI: 0.12‐0.53) from treating those aged ≥35 and 0.28 (95%CrI: 0.12‐0.49) for those with cirrhosis. Globally, treating PWID achieved 1.27 (95%CrI: 0.68‐2.04) IA per treatment. The IA per randomly allocated treatment was positively associated with a country's population growth rate and negatively associated with higher HCV prevalence among PWID. In conclusion, appreciable prevention benefits could be achieved from WHO's treat‐all strategy, although greater benefits per treatment can be achieved through targeting PWID. Higher impact will be achieved in countries with high population growth. [ABSTRACT FROM AUTHOR]

ABSTRACT Hepatitis C virus (HCV) is hypothesised to be a public health problem in Ethiopia, and systematic review evidence suggested 1%–3% seroprevalence. We aimed to estimate the seroprevalence of HCV overall and across regions of Ethiopia. We estimated HCV seroprevalence using the 2016 Ethiopian Demographic and Health Survey (EDHS‐2016). EDHS‐2016 is a nationwide household survey conducted using two‐stage cluster sampling methods. We tested all 26,753 samples from participating adult women (15–49 years) and men (15–59 years) using HCV Enzyme Immunoassay. Descriptive analyses were performed based on the Guide to Demographic Health Survey statistics. We applied sample weighting to derive representative estimates. Of the total tested, more than half (54.40%) were aged 15–29 years and 51.59% were women. Overall HCV seroprevalence was 0.18% (95% Confidence Interval: 0.10–0.32). Higher seroprevalences were found in Afar (0.92%) and South Nations Nationality Peoples Region (0.43%); people living with HIV (PLWH) (0.62%); the poorest wealth index (0.35%); people having multiple lifetime sexual partners (0.31%); and widowed/divorced individuals (0.30%). In stratified analyses by sex and residency, we found higher seroprevalences in non‐Christian and non‐Muslim males (1.98%) and rural population (1.00%), male PLWH (1.67%), rural PLWH (1.45%), widowed/divorced males (0.97%), and in all groups from the Afar region: males (1.30%), females (0.61%), urban (1.07%), and rural (0.86%). HCV seroprevalence among the general population in Ethiopia is much lower than from previous estimates. General population screening is unlikely to be cost‐effective, and so screening programs targeted to people at greater risk of HCV will be required. [ABSTRACT FROM AUTHOR]