Abstract
BackgroundPrevalence of hepatitis C virus (HCV) infection among people who inject drugs (PWID) in Iran is high. Since 2005, the Iranian government has implemented a harm reduction program to control HCV. We aimed to describe the prevalence of HCV antibody (Ab) in Iranian PWID before and after the implementation of harm reduction with cumulative meta-analysis.MethodsFollowing PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the seroprevalence of HCV among PWID. We systematically reviewed the literature to identify eligible studies up to December 2018 in international and national databases. Pooled prevalence and 95% confidence intervals were calculated using Der Simonian and Laird method, taking into account conceptual heterogeneity. Subgroup analyses were performed by harm reduction implementation and studies’ characteristics to assess the sources of heterogeneity. We used Cochran–Armitage test for the linear trend of the prevalence of HCV Ab among PWID.ResultsWe reviewed 5966 papers and reports and extracted data from 62 eligible records. The pooled HCV Ab prevalence among PWID in Iran was 46.5% (95% confidence interval [95% CI] 41.1–52.0%). Overall, the Cochran–Armitage test for trend indicated a significant decreasing trend of HCV Ab prevalence (P = 0.04). The cumulative meta-analysis showed a slight decline in the prevalence of HCV Ab between the years 2005 and 2018.ConclusionsThe HCV Ab prevalence among PWID in Iran is high, with a considerable geographical variation. The prevalence of HCV Ab among PWID in Iran slightly decreased after 2005 which could be, at least to some extent, related to the implementation of extensive harm reduction programs in the country.
Highlights
Hepatitis C virus (HCV) infection is the main global health concern
The prevalence of hepatitis C virus (HCV) Ab was assessed in 27,033 people who inject drugs (PWID) in 62 studies
This study examined the prevalence of HCV Ab before and after implementation of the harm reduction program in PWID in Iran
Summary
Hepatitis C virus (HCV) infection is the main global health concern. The global prevalence of viraemic HCV infection is estimated to be 1% in 2015, corresponding to 71.1 million (62.5–79.4) viraemic infections [1]. Injecting drug use has expanded in the world in the last decades, and it is estimated that 15.6 million people inject drugs worldwide [9]. According to a Harm Reduction International report in 2013 and other sources, it is estimated that there are 170,000 to 230,000 PWID in Iran [10–13]. Iran has one of the highest numbers of people who use drugs (PWUD); many of them have a history of drug injection [14–16]. In Iran, a history of drug use, especially drug injection, is the main risk for transmission of HCV [17, 18]. Prevalence of hepatitis C virus (HCV) infection among people who inject drugs (PWID) in Iran is high. We aimed to describe the prevalence of HCV antibody (Ab) in Iranian PWID before and after the implementation of harm reduction with cumulative meta-analysis
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