Abstract
BackgroundIn 2016, the World Health Organisation set a goal to eliminate viral hepatitis by 2030. Robust epidemiological information underpins all efforts to achieve elimination and this systematic review provides estimates of HBsAg and anti-HCV prevalence in the European Union/European Economic Area (EU/EEA) among three at-risk populations: people in prison, men who have sex with men (MSM), and people who inject drugs (PWID).MethodsEstimates of the prevalence among the three risk groups included in our study were derived from multiple sources. A systematic search of literature published during 2005–2015 was conducted without linguistic restrictions to identify studies among people in prison and HIV negative/HIV sero-status unknown MSM. National surveillance focal points were contacted to validate the search results. Studies were assessed for risk of bias and high quality estimates were pooled at country level. PWID data were extracted from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) repository.ResultsDespite gaps, we report 68 single study/pooled HBsAg/anti-HCV prevalence estimates covering 23/31 EU/EEA countries, 42 of which were of intermediate/high prevalence using the WHO endemicity threshold (of ≥2%). This includes 20 of the 23 estimates among PWID, 20 of the 28 high quality estimates among people in prison, and four of the 17 estimates among MSM. In general terms, the highest HBsAg prevalence was found among people in prison (range of 0.3% - 25.2%) followed by PWID (0.5% - 6.1%) and MSM (0.0% - 1.4%). The highest prevalence of anti-HCV was also found among people in prison (4.3% - 86.3%) and PWID (13.8% - 84.3%) followed by MSM (0.0% - 4.7%).ConclusionsOur results suggest prioritisation of PWID and the prison population as the key populations for HBV/HCV screening and treatment given their dynamic interaction and high prevalence. The findings of this study do not seem to strongly support the continued classification of MSM as a high risk group for chronic hepatitis B infection. However, we still consider MSM a key population for targeted action given the emerging evidence of viral hepatitis transmission within this risk group together with the complex interaction of HBV/HCV and HIV.
Highlights
In 2016, the World Health Organisation set a goal to eliminate viral hepatitis by 2030
A systematic literature search was conducted according to PRISMA guidelines [22] to retrieve, assess and synthesize available data published in the period 2005–2015 on the prevalence of Hepatitis B surface Antigen (HBsAg) and anti-hepatitis C virus (HCV) infection in men who have sex with men (MSM) and people in prison
Literature/database search retrievals The literature search retrieved 9379 citations, from which 17 citations were included for MSM and 57 for people in prison based on title/abstract
Summary
In 2016, the World Health Organisation set a goal to eliminate viral hepatitis by 2030. Chronic infection with the hepatitis B (HBV) or hepatitis C virus (HCV) is a significant cause of liver diseaserelated morbidity and mortality in the European Union/ European Economic Area (EU/EEA) [1]. Both viruses are transmitted through contact with infected blood, blood products and other bodily fluids. HBV is vaccine preventable which, along with other primary prevention measures including health care infection control and antenatal screening, have led to a decrease in acute and chronic hepatitis B (CHB) incidence in many EU/EEA countries [2]. For screening to have a more favourable cost-effectiveness ratio and lead to an overall net gain in population health, current evidence indicates that it should be targeted to higher prevalence populations including PWID and other risk populations, where the expected case yield would be highest. [9, 10] the prevalence threshold above which a favourable cost effectiveness ratio varies considerably between EU/EEA countries
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