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Despite the availability of effective direct‐acting antiviral (DAA) treatments for Hepatitis C virus (HCV) infection, many people remain undiagnosed and untreated. We assessed the cost‐effectiveness of a Médecins Sans Frontières (MSF) HCV screening and treatment programme within a primary health clinic in Karachi, Pakistan. A health state transition Markov model was developed to estimate the cost‐effectiveness of the MSF programme. Programme cost and outcome data were analysed retrospectively. The incremental cost‐effectiveness ratio (ICER) was calculated in terms of incremental cost (2016 US$) per disability‐adjusted life year (DALY) averted from the provider's perspective over a lifetime horizon. The robustness of the model was evaluated using deterministic and probabilistic sensitivity analyses (PSA). The ICER for implementing testing and treatment compared to no programme was US$450/DALY averted, with 100% of PSA runs falling below the per capita Gross Domestic Product threshold for cost‐effective interventions for Pakistan (US$1,422). The ICER increased to US$532/DALY averted assuming national HCV seroprevalence (5.5% versus 33% observed in the intervention). If the cost of liver disease care was included (adapted from resource use data from Cambodia which has similar GDP to Pakistan), the ICER dropped to US$148/DALY, while it became cost‐saving if a recently negotiated reduced drug cost of $75/treatment course was assumed (versus $282 in base‐case) in addition to cost of liver disease care. In conclusion, screening and DAA treatment for HCV infection are expected to be highly cost‐effective in Pakistan, supporting the expansion of similar screening and treatment programmes across Pakistan. [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]

Parasites vary widely in the diversity of hosts they infect: some parasite species are specialists-infecting just a single host species, while others are generalists, capable of infecting many. Understanding the factors that drive parasite host-generalism is of basic biological interest, but also directly relevant to predicting disease emergence in new host species, identifying parasites that are likely to have unidentified additional hosts, and assessing transmission risk. Here, we use mathematical models to investigate how variation in host body size and environmental temperature affect the evolution of parasite host-generalism. We predict that parasites are more likely to evolve a generalist strategy when hosts are large-bodied, when variation in host body size is large, and in cooler environments. We then explore these predictions using a newly updated database of over 20 000 fish-macroparasite associations. Within the database we see some evidence supporting these predictions, but also highlight mismatches between theory and data. By combining these two approaches, we establish a theoretical basis for interpreting empirical data on parasites' host specificity and identify key areas for future work that will help untangle the drivers of parasite host-generalism.This article is part of the themed issue 'Opening the black box: re-examining the ecology and evolution of parasite transmission'., (© 2017 The Authors.)

For many parasites, the full set of hosts that are susceptible to infection is not known, and this could lead to a bias in estimates of transmission. We used counts of individual adult parasites from historical parasitology studies in southern Africa to map a bipartite network of the nematode parasites of herbivore hosts that occur in Botswana. Bipartite networks are used in community ecology to represent interactions across trophic levels. We used a Bayesian hierarchical model to predict the full set of host-parasite interactions from existing data on parasitic gastrointestinal nematodes of wild and domestic ungulates given assumptions about the distribution of parasite counts within hosts, while accounting for the relative uncertainty of less sampled species. We used network metrics to assess the difference between the observed and predicted networks, and to explore the connections between hosts via their shared parasites using a host-host unipartite network projected from the bipartite network. The model predicts a large number of missing links and identifies red hartebeest, giraffe and steenbok as the hosts that have the most uncertainty in parasite diversity. Further, the unipartite network reveals clusters of herbivores that have a high degree of parasite sharing, and these clusters correspond closely with phylogenetic distance rather than with the wild/domestic boundary. These results provide a basis for predicting the risk of cross-species transmission of nematode parasites in areas where livestock and wildlife share grazing land.This article is part of the themed issue 'Opening the black box: re-examining the ecology and evolution of parasite transmission'., (© 2017 The Authors.)