Posted on September 02, 2018

Population health researchers at WCM-Q have published a study that gives a more accurate picture of the epidemiology of hepatitis C infections in the MENA region.

The researchers, led by Dr. Sohaila Cheema and Dr. Karima Chaabna of WCM-Q’s Institute for Population Health (IPH), conducted a comprehensive overview of 37 systematic reviews on hepatitis C in 20 MENA countries published between 2008 and 2016. They then evaluated the quality and precision of each systematic review and the studies they included to determine how useful they were to policy makers attempting to design intervention strategies to eliminate hepatitis C infection from the region. The WCM-Q research, entitled Systematic overview of hepatitis C infection in the Middle East and North Africa, has been published in the World Journal of Gastroenterology.

The overview revealed that several hepatitis C systematic reviews in MENA countries reported general population estimates based on data drawn from mixed populations at differing risk of exposure to the hepatitis C virus (HCV) and over long time periods, in some cases as long as two decades.

Dr. Cheema, director of the Institute for Population Health and assistant professor of healthcare policy and research, said: “The consensus is that the best way to eliminate HCV infection is to focus interventions on at-risk populations, such as people who inject drugs, people who have had blood transfusions, prisoners, and people who engage in risky sexual practices, among others. “Unfortunately, many of the systematic reviews of HCV in the MENA region use data from mixed populations at differing risk of exposure to HCV, rather than targeted sub-sections of the population. In addition, several studies make judgments of the current epidemiology in the region using old data, despite new data being available. This means policy makers are likely to have difficulty using the available systematic reviews to design effective, targeted micro-elimination strategies for HCV.”

It is estimated that 71 million people worldwide have chronic HCV infection, a potentially life-threatening liver infection that is transmitted through blood and other body fluids. The World Health Organization has set a goal of eliminating viral hepatitis by 2030. Because there is no vaccine for pre-emptively protecting people from HCV infections, intervention measures must focus on preventing the infection among the populations at higher risk to HCV exposure and on identifying people with the infection through screening and giving them antiviral drugs. But in order to do this, good quality data is essential. Incidence of HCV infection varies significantly across the MENA countries, with Egypt having one of the highest HCV prevalence rates in the world and Pakistan the second-highest number of chronically infected worldwide. Conversely, in Qatar the prevalence is just 0.9 percent and it is the only MENA country on track for the elimination of HCV by 2030.

Dr. Chaabna, population health and communication specialist, said: “Our study reveals quite serious limitations with many of the hepatitis C systematic reviews reporting data on the MENA region. We believe that in order to achieve the goal of HCV infection elimination by 2030, up-to-date, good quality data that focuses precisely on at-risk populations is needed in order to help policy makers plan micro-elimination strategies in MENA, which our study will certainly help achieve.” Dr. Ravinder Mamtani, senior associate dean for population health, capacity building and student affairs at WCM-Q and senior co-author on the study said: “WCM-Q is at the forefront of engaging in cutting-edge population health research and this study, undertaken by us, is a case in point.”

Other researchers who contributed to the study were Dr. Amit Abraham and Dr. Hekmat Alrouh, both of WCM-Q, Dr. Albert B. Lowenfels of New York Medical College, Valhalla, New York, and Dr. Patrick Maisonneuve of the European Institute of Oncology, Milan, Italy.