Abstract
BackgroundDespite a dramatic reduction in HCV drug costs and simplified models of care, many countries lack important information on prevalence and risk factors to structure effective HCV services.MethodsA cross-sectional, multi-stage cluster survey of HCV seroprevalence in adults 18 years and above was conducted, with an oversampling of those 45 years and above. One hundred forty-seven clusters of 25 households were randomly selected in two sets (set 1=24 clusters ≥18; set 2=123 clusters, ≥45). A multi-variable analysis assessed risk factors for sero-positivity among participants ≥45. The study occurred in rural Moung Ruessei Health Operational District, Battambang Province, Western Cambodia.ResultsA total of 5098 individuals and 3616 households participated in the survey. The overall seroprevalence was 2.6% (CI95% 2.3–3.0) for those ≥18 years, 5.1% (CI95% 4.6–5.7) for adults ≥ 45 years, and 0.6% (CI95% 0.3–0.9) for adults 18–44. Viraemic prevalence was 1.9% (CI95% 1.6–2.1), 3.6% (CI95% 3.2–4.0), and 0.5% (CI95% 0.2–0.8), respectively. Men had higher prevalence than women: ≥18 years male seroprevalence was 3.0 (CI95% 2.5–3.5) versus 2.3 (CI95% 1.9–2.7) for women. Knowledge of HCV was poor: 64.7% of all respondents and 57.0% of seropositive participants reported never having heard of HCV.Risk factor characteristics for the population ≥45 years included: advancing age (p< 0.001), low education (higher than secondary school OR 0.7 [95% CI 0.6–0.8]), any dental or gum treatment (OR 1.6 [95% CI 1.3–1.8]), historical routine medical care (medical injection after 1990 OR 0.7 [95% CI 0.6–0.9]; surgery after 1990 OR 0.7 [95% CI0.5–0.9]), and historical blood donation or transfusion (blood donation after 1980 OR 0.4 [95% CI 0.2–0.8]); blood transfusion after 1990 OR 0.7 [95% CI 0.4–1.1]).ConclusionsThis study provides the first large-scale general adult population prevalence data on HCV infection in Cambodia. The results confirm the link between high prevalence and age ≥45 years, lower socio-economic status and past routine medical interventions (particularly those received before 1990 and 1980). This survey suggests high HCV prevalence in certain populations in Cambodia and can be used to guide national and local HCV policy discussion.
Highlights
Despite a dramatic reduction in Hepatitis C Virus (HCV) drug costs and simplified models of care, many countries lack important information on prevalence and risk factors to structure effective HCV services
The p-value of the Hosmer Lemeshow test that assesses the goodness-of-fit of the model was less than 0.05. This survey is the first of its kind in size and rigor in Cambodia, with findings that: HCV prevalence is higher in people ≥45 years and among those with less education, that there is sometimes wide geographic variability in HCV estimates, and that HCV disease is poorly understood even among the seropositive
The 2.6% prevalence seen in this population was far lower than the 14.7% seen in blood donors in 2009, and was half the rates (5.8 and 5.2%) from observational studies of people living with Human immunodeficiency virus (HIV) (PLHIV) [7–9]
Summary
Despite a dramatic reduction in HCV drug costs and simplified models of care, many countries lack important information on prevalence and risk factors to structure effective HCV services. Though newer Direct Acting Antivirals (DAA) are safer, more effective and easier for patients than previous HCV treatment, the extremely high treatment cost (up to $150,000 per patient) prohibited their widespread access and use, outside of well-resourced health systems [1, 2]. Adjusted models-of-care in low-resource settings are treating more patients, as effectively, for a fraction of previous prices (cost-per-cure in a 2018 Cambodian cohort dropped from $1172 to $370) [4]. Widespread access to treatment is becoming a more realistic goal, encouraging Ministries of Health (MoH) and donors in low-resource settings to expand HCV treatment as part of the global push towards the elimination of viral hepatitis by 2030, a goal adopted in 2016 by the World Health Assembly [1, 5]
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